Chapter 12-Wrist and Hand Injuries

1. Chapter 12-Wrist and Hand Injuries

2. Objectives • Understand the basic anatomy of the wrist and hand. • Explain various types of injuries that occur to the wrist and hand. • Understand common mechanisms that cause injuries to the wrist and hand. • Understand the signs and symptoms of the various types of fractures of the wrist and hand.

3. Anatomy

4. Anatomy-Carpal Bones • “Some lovers try positions that they can’t handle” • Scaphoid, Lunate, Triquitral, Pisiform, Trapezium, Trapezoid, Capitate, Hamate • http://www.gwc.maricopa.edu/class/bio201/hand/awrist.htm

5. Anatomy-metacarpals and phalanges • Labels 1-5, beginning at thumb • 5 metacarpals (each hand) • 14 phalanges (each hand) • Phalanges classified as proximal, middle and distal phalanx

6. Anatomy-joints • Named for the bones that comprise them • Carpometacarpal (CMC) • Metacarpal phalangeal (MCP) • Proximal interphanlageal (PIP) • Distal interphalangeal (DIP) • http://www.gwc.maricopa.edu/class/bio201/hand/anhand.htm

7. Anatomy-muscles • flexor groups

8. Anatomy-muscles • Extensors

9. Anatomy-hand • Adductors and Abductors of phalanges

10. Anatomy-muscles • Thenar eminence

11. Anatomy-muscles • Hypothenar eminence

12. Anatomy-Ligaments • Mostly intrinsic due to need for bones to be connected • Radial and ulnar collateral • Flexor retinaculum or transverse carpal ligament • Stablizes carpals, covers flexor tendons and median nerve

13. Anatomy-ligaments • Thumb • Ulnar collateral of the thumb • Radial collateral of the thumb • Provide joint stability to thumb

14. Injuries • Prevention • Braces • Tape • Gloves • Padding

15. Ligament Injuries • Wrist sprains • Often caused by overuse, falls, and forceful twisting motion • Injury side depends on side of twist/overstretch • S/S- pain, decreased ROM, decreased grip strength, possible swelling • PRICE • Taping for support • Rehab focuses on establishing normal ROM and return to normal strength

16. Dislocated lunate • Most commonly dislocated carpal bone • Causes deformity, pain, swelling, and decreased ROM • Splint and refer • Physician relocates

17. Ganglion Cyst • Fluid within the muscle sheath • Treat with ice and activity modification • Refer to physician if symptoms persist

18. Gamekeeper’s Thumb • Injury to the medial collateral ligament • aka skier’s thumb • Usually caused by forced abduction • Pain and swelling likely • Treat with ice and splinting of medial aspect of thumb • Should have x-ray

19. Interphalangeal collateral ligament sprains • “jammed” finger • Often caused by finger hit by ball • Swelling, pain, discoloration • May refer for x-ray • Ice, buddy tape, possible padding

20. Dislocations of ICP or MCP joints • One bone usually moves volar (palm side), and one dorsal • Refer to physician for relocation because of tiny tendons, nerves and blood vessel movement • Improper relocation can cause permanent damage

22. Tendinitis • Inflammation of tendon • Caused by overuse, stretching or impact • Prevent by increasing strength and flexibility

23. De Quervain’s tendinitis • Affects abductor pollicis longus and extensor pollicis brevis • Shot-putters are vulnerable • Difficulty abducting, swelling, crepitis • Limit activity, PRICE

24. Mallet finger • Result of direct impact • Caused by tearing of extensor tendon from bone • Cannot extend tip of finger due to tendon disruption • Pain, swelling, need to splint in extension and refer • Possible treatment- sugery or splint • If not treated, finger will remain in permanent flexion

25. Jersey finger • Similar to mallet finger except injury it to flexor tendon • Inability to flex DIP joint • Named from moi, holding jersey with fist and finger forced to extend, tearing tendon • Causes pain and swelling • Splint, ice, and refer

26. Boutonniere deformity • Occurs at PIP join • Caused by hard impact over PIP, results in tear in the joint capsule, extensor tendons fall laterally • Extensors contract and force flexion of the PIP and extension of DIP • Pain and swelling • Splint and refer • Continued splint or surgery are treatments

28. Scaphoid fracture • Commonly caused by falling on outstretched hand • Pain, swelling, decreased ROM • Refer for x-ray • Casting common • Untreated or improperly treated can cause a non-union fracture and/or avascular neucrosis

29. Complications of scaphoid fracture • Avascular neucrosis • lower half of the fractured bone loses its blood supply and actually dies • Can eventually lead to degenerative arthritis • Non-union fracture • If fx does not heal properly, surgery may be required

30. Boxer’s fracture

31. Boxer’s fracture • most common type of metacarpal fracture • point of maximal tenderness is just proximal to the knuckle • Caused by direct blow/punch • Ice, splint, and refer

32. Colle’s fracture • caused by falling forward onto an outstretched arm • sometimes called a 'dinner fork‘ • Splint and refer for x-ray and treatment

33. Smith’s fracture • Similar to Colle’s fracture, but wrist in flexion • patient lands with the wrist in flexion

34. Carpal tunnel syndrome • caused when too much pressure is put on the median nerve • Check with Tinel’s test or Phalen’s test • Refer to physician for recommended treatment