Hand and Forearm Flashcards
Colles’ Fracture
A fracture to the distal end of the radius or ulna.
Caused by a fall on an outstretched hand, forcing radius and the ulna into hyperextension.
Smith Fracture
Anterior displacement of the distal fragment. (kind of part of the Colles’ fracture).
Sx’s of Colles’ Fracture or Smith Fracture
Forward displacement of the radius causing visible deformity (dinner fork deformity).
When no deformity is present, this can be mistaken for a wrist sprain.
Extensive internal bleeding and swelling.
Complications may include torn or avulsed tendons and median nerve damage.
Triangular Fibrocartilage Complex
Caused by forced hyperextension, falling on outstretched hand.
Violent twist or torque of the wrist.
Often associated with sprain of the UCL.
Sx’s
Pain along the ulnar side of the wrist, difficulty with wrist extension, possible clicking.
Swelling is possible, although there may not be much swelling initially.
Athlete may not report this injury immediately.
Triangular Fibrocartilage Complex Management
reer to physician for evaluation, x-ray and treatment.
Immobilization is required. Initially 4 weeks.
Followed by rehabilitation program focusing on strengthening and restoration of full ROM.
Surgical intervention may be required if conservative treatments don’t work.
Nerve Compression, Entrapment, Palsy
Median and ulnar nerve compression. results of direct trauma to nerves, or overuse.
Sx’s
Sharp or burning pain associated with skin sensitivity of parasthesia.
May result in benediction/bishop’s deformity or claw hand deformity.
Palsy or radial nerve produces drop wrist deformity caused by paralysis of extensor muscles.
Palsy of median nerve can cause ape hand.
Carpal Tunnel Syndrome
Caused by:
Compression of the median nerve due to inflammation of tendons and sheaths of carpal tunnel.
Result or repeated writst flexion or direct trauma to anterior aspect of wrist. Fall on an outstretch hand.
Tenosynovitis of flexor tendons
complications of a Colles’ FX or Carpal FX.
Mass putting pressure on the tunnel.
Swelling within tunnnel puts pressure on tendons and median nerve.
Carpal Tunnel Syndrome Sx’s
sensory and motor deficits Tingling, numbness and paresthesia Pain Digits 2-4 Deep pressure will increase pain and may cause numbness. Thumb weakness Pain, numbness and/or tingling at night.
de Quervain’s Disease (Hoffman’s Disease)
Caused by stenosing tenosynovitis in the thumb (extensor pollicis brevis and abductor pollicis longus.
Overuse.
Sx’s
Aching pain, which may radiate into the hand or forearm.
Positive Finkelstien’s test
Point tenderness and weakness during thumb extension and abduction, painful catching and snapping.
Dislocation of the Lunate
Caused by forceful hyperextension. A fall on an outstretched hand.
Sx’s
Pain, swelling, difficulty performing wrist and finger flexion.
Numbness/paralysis of flexor muscles due to pressure on median nerve.
Management: refer for reduction Ice, splint deterioration of the bone can occur, requiring surgical removal. Recovery time is typically 1-2 months.
Kienbock’s Disease
Caused by a loss of blood supply to the lunate bone resulting in osteonecrosis.
Sx’s:
Pain, swelling, decreased ROM
Decreased grip strength.
Tenderness over the bone (middle of the dorsum of the wrist).
Management:
Early treatment involves immobilization and NSAID’s.
Operative treatment may be required if conservative treatment fails.
Scaphoid Fracture
Caused by falling on an outstretch hand.
Compressing scaphoid between the radius and second row of the carpal bones.
Often fail due to poor circulation.
Sx's: Swelling Severe Pain in the "anatomic snuff box" Presents like a wrist sprain. Pain with radial flexion.
Very long recovery.
Hamate Fracture
Caused by falling or contact with equipment.
Sx’s:
Wrist pain and weakness
Point Tenderness
Pull of muscular attachment can cause a non-union fracture.
Cast.
Wrist Ganglion
A synovial cyst ( a herniation of a joint capsule or synovial sheath). Can also be caused by a wrist strain.
Sx’s:
Area of swelling
Pain that increases with use
Decreased ROM
Treatment: Aspiration, chemical cauterization, pressure pad. Surgical removal.
