wrist and hand injuries Flashcards
what movements occur in the forearm?
pronation/supination (between radius and ulna)
which carpals make up the proximal row?
scaphoid, lunate, triquetrum, pisiform
which carpals make up the distal row?
trapezium, trapezoid, capitate, hamate
anterior forearm muscles
- wrist and finger flexors
- common origin in medial epicondyle
- ulnar and median nerve
posterior forearm muscles
- wrist and finger extensors
- common origin on lateral epicondyle
- radial nerve
thenar compartment of the hand
- thumb muscles
- median nerve
hypothenar compartment of the hand
- 5th digit muscles
- ulnar nerve
central compartment of the hand
- lumbricals, palmar, and dorsal interossei and adductor pollicis
- ulnar nerve
what is supplied by the radial nerve?
supplies more of the dorsal aspect of the hand for sensory (vs muscle contraction)
forearm fracture - MOI
- direct blow or FOOSH
- common among active children and youth
- typically involve both radius and ulna
S&S of forearm fracture
- pop or snap
- pain, swelling, and deformity
- localized edema and ecchymosis
what is a secondary complication of forearm fractures?
Volkmann’s contracture
- brachial artery is compromised = ischemic muscle degradation and necrosis
- delays in treatment longer than 4-6 hours may cause irreversible damage
what is the most common forearm fracture?
colles’ fracture
colles fracture - def
fracture of radius, with a posterior displacement
smith fracture
-opposite of colles’ fracture, anterior displacement of radius
colles’ fracture MOI
FOOSH with wrist in hyperextension
S&S of colles’ fracture
visible ‘dinner fork’ deformity
forearm fracture - management
- POLICE
- immobilize elbow joint and wrist joint
- fingers exposed to monitor MSC
- sling and swathe
- refer immediately to physician
- severe sprains should be treated as possible fractures
- xray evaluation required to confirm/rule out fracture
- colles’ fracture in children/youth can be an epiphyseal fracture
- cast for 6-8 weeks
- followed by rehabilitation program to address ROM and strength
MOI - wrist sprain
- acute: FOOSH (single episode trauma)
- chronic: repetitive stress (forceful hyperextension)
- gymnast: vaulting, floor, pommel
S&S of wrist sprain
-pain, swelling, and difficulty moving wrist in all ROM
management of wrist sprain
- POLICE
- referral to physician to assess for fractures
- severe wrist sprain and scaphoid fracture often mistaken for each other
what is the most frequently fractured carpal bone?
scaphoid
wrist fracture - scaphoid: MOI
- FOOSH
- compresses scaphoid between radius and 2nd row of carpal bones
S&S of wrist (scaphoid) fracture
- carpal swelling
- point tenderness in anatomical snuffbox
- pain with long axis pressure along thumb
management of wrist (scaphoid) fracture
- initial xray often negative and this no immobilization
- fracture often has poor healing due to lack of splinting or inadequate blood supply
- leading to degeneration and avascular necrosis
management of scaphoid fracture
-re-evaluate if point tenderness persists following initial negative xray
- cast for 6-8 weeks, including thumb immobilization
- if proper healing occurs, strengthening rehabilitation follows
- with non-union, internal fixation/bone graft may be required
MOI - hook of hamate fracture
- contact from holding athletic equipment
- such as racket/stick/golf club
S&S of hook of hamate fracture
- wrist pain and weakness
- point tenderness palmar hypothenar
- ulnar nerve neuropathy
management of hook of hamate fracture
- casting
- protect with doughnut padding when RTP
what is the most common carpal bone to dislocate?
-lunate (although injury is infrequent)
MOI - lunate dislocation
- FOOSH
- creates space between distal and proximal carpal bones
- lunate dislocated anteriorly (palmar side)
S&S of lunate dislocation
- pain, swelling, and difficulty executing wrist and finger flexion
- may include numbness or paralysis of flexor muscles if median nerve is compressed
management of lunate dislocation
-referral to physician for xray evaluation and reduction
wrist tendinitis
- flexor carpi radialis and flexor ulnaris
- repetitive wrist flexion activities
- S&S: pain with active use, passive stretch and isometric resistance
tenosynovitis of wrist
- extensor carpi radialis longus or brevis (“trigger finger” = secondary complication)
- repetitive wrist acceleration and decelerations
- S&S: pain with active use and passive stretch; tenderness and swelling
management of wrist tendinitis and tenosynovitis
- acute pain and inflammation: ice massage, NSAIDs and rest
- wrist splint to protect tendons
After pain and swelling subsides:
1) ROM exercises
2) strengthening exercises
deQuervain’s syndrome
- tenosynovitis of extensor pollicis brevis and abductor pollicis longus
- tendons move through the same synovial sheath under extensor retinaculum
S&S of deQuervain’s syndrome
- aching pain, radiating into hand/forearm
- increased pain with wrist movements
- point tenderness and weakness with thumb extension and abduction
- positive Finklestein’s test
management of deQuervain’s syndrome
- immobilization, rest, and anti-inflammatory meds
- ultrasound and ice massage
game keeper’s thumb
- sprain of the ulnar collateral ligament of the MCP joint of the thumb
- common in skiers and tackle football
MOI of game keeper’s thumb
- forceful adduction of the proximal phalanx (and hyperextenison)
- ex: fall while holding ski pole
S&S of game keeper’s thumb
- pain and swelling over UCL (medial aspect of thumb)
- pinching action weak and painful
management of game keeper’s thumb
- instability: surgical repair necessary for RTP
- stable: xray to rule out fracture, splint distal thumb to wrist in neutral and tape for RTP
bennett’s fracture
- fracture in the 1st MC just distal to the CMC joint of the thumb
- axial and abduction force
- pain and swelling over base of thumb
- CMC deformity
- requires surgical fixation
boxer’s fracture
fracture of the 5th MC
- axial or compressive force
- pain and swelling in 5th MC - deformity
- POLICE, reduction, and splint
interphalangeal joint sprains
- can affect DIP or PIP
- excessive varus or valgus force
- pain and swelling at joint
- POLICE, xray
- buddy taping or splint
IP and MCP joint dislocations
- twisting or shear force
- angular or rotational deformity
- pain and swelling over joint
- POLICE, xray, reduction, splinting, protect for RTP
mallet finger
- rupture of extensor tendon from distal phalanx - can be avulsion
- blow to tip of finger or jamming finger
- pain in distal phalanx
- unable to extend distal phalanx - DIP joint in approx. 30 deg flexion
- POLICE and splint DIP in extension
boutonniere deformity
- rupture of the extensor tendon dorsal from middle phalanx
- trauma to tip of finger
- pain in distal phalanx
- unable to extend distal phalanx
- DIP forced into extension and PIP into flexion
-POLICE and splint PIP in extension
swan neck deformity
- tear of the volar plate from the middle phalanx
- severe PIP hyperextension (MOI)
- pain and swelling in PIP
- PIP joint passively hyperextended compared to other PIP joints
- DIP flexion and PIP hyperextension
-POLICE and splint PIP in slight flexion
jersey finger
- rupture or avulsion of the flexor digitorum profundus tendon from its distal insertion on the distal phalanx
- most often ring finger
- grabbing an opponent’s jersey
- pain over distal phalanx
- DIP joint cannot be flexed
- finger in extended position
- weakness in grip strength
- surgical repair
