Chapter 15 – The Wrist, Hand, and

FingersPages 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 Fracture may compromise nutrition to proximal

end High incidence of nonunion or malunion fractures

secondary to avascular necrosis Figure 15-27, page 557

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

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

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

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

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

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

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

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

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

Metacarpal Fractures Long bone compression test

Figure 15-29, page 559

Boxer’s fracture Fifth metacarpal Depressed 5th MCP joint

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)