INJURY EVALUATION For The Fingers, Hand, & Wrist

1. Sports Medicine INJURY EVALUATION For The Fingers, Hand, & Wrist PROPERTY OF PIMA COUNTY JTED, 2010

2. Bellwork • Think-Pair-Share your responses to the following questions: • 1. What are some of the signs and symptoms associated with the injuries of the hand and wrist? • 2. What treatment options would you recommend for injuries of the hand?

3. OBJECTIVES: • Define and recall key evaluation terminology. 2. Use effective questioning techniques to gather pertinent information. 3. Justify appropriate evaluation techniques using organizational tools. 4. Accurately record data to evaluate injury.

4. HOPS/SOAP REVIEW History—questions to determine the nature & location of injury Observation—visual examination of injury Palpation—thehands-on exam Stress tests—tests to check range of motion and degree of injury • Subjective—detailed information about patient history, complaints • Objective—date and other information from inspection & palpation and recorded • Assessment--identification of problem • Plan of Action-treatment

5. Teacher and Student Demonstration • A basketball player attempts to catch a pass from a teammate. The ball hits the tip of his finger and bounces off. The player comes to the athletic training room complaining of pain over the 2nd DIP. He says that he injured the same finger during last week’s game. You notice his finger is beginning to swell.

6. TIP! The athlete’s well-being WILL depend on the accuracy and thoroughness of your EVALUATION! Ask probing questions and record accurately! Review your notes with the athlete after you have completed your evaluation! “This is what I heard you say…”

7. SOAP Note Writing Practice: Using the information on Sample Scenario, write the following SOAP note template. Name of Athlete: Date of Examination: Date of Injury: Place of Injury: S: O: A: P: (Leave 6-7 lines between each letter on your paper to allow for notetaking)

8. HOPS • History • Previous injury/family history? Was it this bad before? How was it treated? What happened? When? What did you hear/feel? Pain scale? What positions make it feel better/worse? What have you done to help it? Numbness or tingling? • Observation • Deformities? Wounds? Contusions? Swelling/discoloration? Finger contractures? • Palpation • Bones (fractures), Ligaments (sprains), Muscles/Tendons (strains)

9. ALWAYS COMPARE BILATERALLY!!!!

10. Special TestsRange of Motion & Strength Tests • What motions are available at the wrist? • Which type of ROM should be tested first? • ALWAYS COMPARE BILATERALLY STARTING WITH THE GOOD SIDE & ACTIVE MOVEMENT! • Only evaluate strength if there is adequate AROM & PROM.

11. Valgus & Varus Tests • Evaluates the wrist RCL (varus) & UCL (valgus), MCP joints, & IP joints • Stabilize the GOOD wrist first, holding the patient’s forearm & hand in each of your hands. Starting at the wrist collateral ligaments, passively ulnar deviate to perform the varus test for the RCL. Radial deviation, the varus test, will evaluate the UCL. For the MCP joints, stabilize the metacarpal, & the involved digit, then apply valgus & varus force. For the IP joints, stabilize their hand & the proximal part of the finger. Apply valgus & varus force to the middle phalanx to test the PIP joints. Apply force to the distal phalanx to test the DIP joints. • (+) Pain, laxity

13. Finkelstein’s Test • Evaluates for de Quervain’s Tenosynovitis • Instruct your patient to hold their arms next to each other, elbows flexed, hands in fists with their thumbs TUCKED IN, pinkies down. With the good hand first, the patient will gently ulnar deviate as far as possible. • *This is a slow, active movement! • (+) Pain, unwillingness to move, significant difference in ROM

14. Tinel’s Sign • Evaluates for carpal tunnel syndrome • Stabilize the patient’s good wrist in your hand, supinated & slightly extended. Using two fingers, firmly tap 2-5 times directly over the carpal tunnel. Ask the patient if there is any pain or altered sensation in the thumb, middle, or index finger. • (+) Numbness/tingling in the fingers, pain, altered sensation side-to-side.

15. Glide Test • Evaluates for intercarpal ligament sprain • Stabilize your patient’s GOOD WRIST & hand first. Start on the side of their carpals away from pain, firmly grip between two carpals & apply anterior & posterior movement to check the integrity of each of the intercarpal ligaments. Glide forces can also be applied to the metacarpals to check for possible fracture. • (+) Pain, crepitus, increased laxity

16. Axial Load Test • Evaluates for a scaphoid fracture – or first metacarpal • Starting with your patient’s good wrist, stabilized their forearm & hand, in a neutral position. Grab their uninjured thumb first, passively abduct & extend it, then apply an axial load to the digit. • (+) Pain in the anatomical snuffbox (intense!)

17. Metacarpal Squeeze Test • Evaluates for possible metacarpal fracture • Continue with the patient’s good wrist in a stabilized & neutral position in your hand. Firmly, but not with full strength, squeeze their palm (metacarpals 2-5), feeling for crepitus or shifting. • (+) PAIN! Crepitus or shifting

18. TFCC Load Test • Evaluates the ___________?! for tears or compression injuries • Your patient’s good wrist should be pronated with their forearm & hand stabilized in each of your hands. Passively ulnar deviate as far as possible, then apply axial force through the fifth metacarpal onto the TFCC. • (+) Pain in the TFCC

19. Sample Scenario—Break this Down! • A receiver on the football team was attempting to catch a pass. He dove after the ball, landing on his outstretched wrist. He got up and came to the sideline, complaining of pain over the thumb side of his R wrist & hand. There was no previous injury history. • You perform a bilateral observation of his hand/wrist. There is no swelling, discoloration or obvious deformity.

20. On Your Own! Directions: Each person will complete an individual SOAP note for the scenario. Check your SOAP note for accuracy and readability. Turn your SOAP note in for assessment and feedback from your teacher.