Hand Injuries

Question 1

What do the metacarpals do?

Answer 1

They’re the 5 bones for movement

Question 2

What do the phalanges do?

Answer 2

They’re the 14 bones for fine motor movement

Question 3

How many phalanges do we have?

Answer 3

14

Question 4

How many metacarpals do we have?

Answer 4

5

Question 5

What do ligaments do?

Answer 5

They hold bones/joints together

Question 6

What do tendons do?

Answer 6

They attach muscles to bones

Question 7

What do bony injuries include?
(4)

Answer 7

Fracture

Dislocation

Crush

Amputation

Question 8

What do soft tissue injuries involve?
(3)

Answer 8

Ligaments

Tendons

De-glove injury

Question 9

What are the 2 types of injury to the hand, fingers and thumb?

Answer 9

Bony injury

Soft tissue injury

Question 10

What are the types of acute injuries?
(3)

Answer 10

Fractures/breaks

Dislocations

Soft tissue injuries

Question 11

What can fractures/breaks be?
(3)

Answer 11

Avulsion fracture

Crush injuries

Amputation

Question 12

What can dislocations be?
(2)

Answer 12

Partial

Complete

Question 13

What can soft tissue injuries be?
(3)

Answer 13

Injury to ligaments

Injury to tendons

Foreign bodies, such as glass or stone

Question 14

What are the types of bone fractures?
(9)

Answer 14

Open

Closed

Transverse

Sigmental

Green stick

Spiral

Linear

Comminuted

Impacted

Question 15

What is a fracture?

Answer 15

A partial or complete break in a bone, e.g. due to acute trauma, twisting, trapping/crush

Question 16

What are the standard x-ray projections for a fracture?
(3)

Answer 16

Dorsi-palmar (DP)

Oblique

Lateral view

Question 17

What are common ways that people get acute hand injuries?
(3)

Answer 17

Punch injury

Trapped in car door

Sports injuries

Question 18

Which bone can be affected by trapping your hand in a car door?

Answer 18

Distal phalanx

Question 19

Which bones can be affected by sports injuries?
(3)

Answer 19

Hyper extension of the thumb

Dislocated 1st metacarpal or phalanx

Hyper extension of the fingers or phalanx

Question 20

What are dislocations?

Answer 20

The separation of 2 bones at a joint where they normally meet

Question 21

What is the most common way that people dislocate their hand?

Answer 21

Punch injury

Question 22

What projection views should be done for a hand dislocation?
(3)

Answer 22

DP

Oblique

Lateral

Question 23

Why is a lateral hand view done for a dislocation?

Answer 23

For degree of volar angulation

Question 24

What does volar angulation mean?

Answer 24

Towards the palm

Question 25

What are the stages of treatment for a hand dislocation? (5)

Answer 25

Initial x-ray request to review the extent of injury Theatre (during manipulation) Post manipulation x-ray for the surgeon to check for position and to visualise any fractures Immobilisation, e.g. cast, splint Follow-up imaging via fracture clinic

Question 26

What are the soft tissue injuries that you can get in the fingers? (2)

Answer 26

Volar plate injuries Tendon disruption

Question 27

What is a volar plate?

Answer 27

A small piece of ligament

Question 28

What does the volar plate do?

Answer 28

It helps to structure the proximal and distal phalanx joints

Question 29

What’s an example of tendon disruption? What does it do?

Answer 29

Mallet finger deformity Inability to extend the distal phalanx Hyper extension

Question 30

What are examples of injuries we can get in the thumb? (2)

Answer 30

Ligament injuries Fractures Dislocations

Question 31

What are examples of ligament injuries in the thumb? (2)

Answer 31

Sprained thumb Skiers thumb

Question 32

What are examples of fractures that could happen in the thumb?

Answer 32

Bennett or Rolando

Question 33

What does a thumb fracture look like?

Answer 33

The small fractured fragment remains in tact with the trapezium

Question 34

What are examples of reasons for non-acute injury hand x-ray requests? (5)

Answer 34

To check for: Bone age Rheumatoid arthritis Tumours Marfans Suspected physical abuse (SPA)

Question 35

What does bone age mean?

Answer 35

Determining the skeletal age

Question 36

Why is it important for x-rays to determine bone age?

Answer 36

Those images are compared to a standard atlas of bone development

Question 37

What are the features of x-raying a hand to reveal the bone age? (4)

Answer 37

DP hand projection Non-dominant hand Wrist, 3rd metacarpal and 3rd finger aligned No lateral requires

Question 38

What is rheumatoid arthritis?

Answer 38

A chronic long term condition where there’s pain, stiffness and swelling in the joints

Question 39

What can rheumatoid arthritis cause? (3)

Answer 39

The lining of the joint to become inflamed Damage to joint tissue Deformity

Question 40

Where can rheumatoid arthritis happen? (3)

Answer 40

Hands Wrist Feet

Question 41

What projections are done when x-raying for rheumatoid arthritis? (2)

Answer 41

DP Oblique

Question 42

What are examples of bone tumours in the hand? (3)

Answer 42

Osteoid osteoma Enchondromas Ganglion cysts

Question 43

What is marfans syndrome?

Answer 43

When someone has long metacarpals (spider fingers)

Question 44

What x-ray projection can be done on a hand with marfans syndrome?

Answer 44

DP

Question 45

Why would a hand x-ray be done if there’s suspected child abuse? (3)

Answer 45

To check for evidence of child abuse To check the hand and wrist bone ossification A fracture is highly indicative of abuse

Question 46

What type of body part does CT reveal?

Answer 46

More detailed bony anatomy

Question 47

What type of body part does MRI reveal?

Answer 47

Soft tissue

Question 48

What type of body part does ultrasound reveal?

Answer 48

Joint effusions (fluid/swelling within the joint)