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Chapter 15 – The Wrist, Hand, and Fingers

Chapter 15 – The Wrist, Hand, and Fingers. Pages 556 - 559. Hand Pathology. Most injuries have acute onset Hyperflexion/hyperextension of wrist Axial load of metacarpal bones Crushing forces. Scaphoid Fractures. Bony block for wrist extension Blood supply Receives from distal end

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Chapter 15 – The Wrist, Hand, and Fingers

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  1. Chapter 15 – The Wrist, Hand, and Fingers Pages 556 - 559

  2. Hand Pathology • Most injuries have acute onset • Hyperflexion/hyperextension of wrist • Axial load of metacarpal bones • Crushing forces

  3. Scaphoid Fractures • Bony block for wrist extension • Blood supply • Receives from distal end • Fracture may compromise nutrition to proximal end • High incidence of nonunion or malunion fractures secondary to avascular necrosis • Figure 15-27, page 557

  4. Scaphoid Fractures • Preiser’s Disease • Osteoporosis of scaphoid due to fx or repeated trauma • Signs and Symptoms • Aching pain in anatomical snuffbox area • Grip strength decreased • Evaluative Findings • Table 15-9, page 558

  5. Scaphoid Fractures • Pain in anatomical snuffbox area after hyperextension mechanism should be treated as scaphoid fracture • Treatment • Immobilization of wrist and thumb • Referral to physician • Fx may not be visible on x-ray right away

  6. Scaphoid Fractures • Conservative Treatment • Short arm thumb spica cast • Long arm thumb spica cast • Eliminates pronation and supination • May decrease risk of non- and malunions • Surgical Treatment • Displaced fractures • Some may chose to immediately fixate fracture • After healing phase, ROM and strengthening

  7. Perilunate and Lunate Dislocation • Series of events • As limits of wrist/hand extension are exceeded– scaphoid strikes radius • Rupturing of volar ligaments that connect scaphoid to lunate • As force continues, distal carpal row is stripped away from lunate • Lunate rests dorsally relative to other carpals • This is a Perilunate Dislocation

  8. Perilunate and Lunate Dislocation • Series of events cont. • Further extension leads to rupture of dorsal ligaments • This relocates the carpals and rotates the lunate • Lunate rests volarly relative to other carpals • This is a lunate dislocation • Either dislocation may spontaneously reduce

  9. Perilunate and Lunate Dislocation • Signs and Symptoms • Pain along radial side of palmar or dorsal aspect of wrist that limits ROM • Bulge may be visible on dorsal or palmar aspect proximal to third metacarpal • Paresthesia in middle finger • Fracture of scaphoid should be suspected

  10. Perilunate and Lunate Dislocation • Evaluative Findings • Table 15-10, page 558 • Kienbock’s Disease • Osteochondritis or slow degeneration of lunate • Due to repetitive trauma that may compromise vascular supply • May result in loss of ulnar deviation, tenderness, pain, swelling, decreased grip strength • Characteristic – pain during passive extension of third finger

  11. Perilunate and Lunate Dislocation • Treatment • Closed reduction and immobilization in flexion for 6-8 weeks • Frequent follow-ups • Pinning may be needed if reduction is lost

  12. Metacarpal Fractures • Common for athlete to hear the bone snapping as it fractures • Immediate pain • Gross deformity may be visible or obscured by swelling (Figure 15-28, page 559) • Palpation reveals tenderness, crepitus, false joint • Evaluative Findings • Table 15-11, page 560

  13. Metacarpal Fractures • Long bone compression test • Figure 15-29, page 559 • Boxer’s fracture • Fifth metacarpal • Depressed 5th MCP joint

  14. Metacarpal Fractures • Treatment • If no rotation – casting • With rotation – open reduction with internal fixation • After healing phase – ROM and strengthening (approximately 8 weeks after fracture)

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