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Wrist and Hand injuries
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Carpals
• 2 rows, lateral to
medial
– Distal
• Trapezium, trapeziod,
capitate, hamate
– Proximal
• Scaphoid (navicular)
lunate, triquetral,
pisiform
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Metacarpals
• 5 bones
• Numbered 1 through 5
• Thumb is #1
• Pinky is #5
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Phalanges
• 5 proximal
• 4 middle
• 5 distal
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Joints
• Distal radioulnar
• Carpal
• Carpometacarpal
• Metacarpalphalangeal
(MCP)
• Interphalangeal (PIP and
DIP)
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Muscles
• Intrinsic muscles
– Originate in the hand
– Thenar and hypothenar eminence
• Actions include abduction/adduction & opposition of
thumb
• Extrinsic muscles
– Originate outside the hand
• Actions include flexion/extension of wrist, hand, fingers
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Bones most often injured
• Radius
• Ulna
• Lunate (dislocation)
• Scaphoid (fracture in anatomical snuffbox)
• Metacarpals
• Phalanges
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Wrist Injuries
• Colle’s Fracture
• Sprain
• Tendonitis
• Ganglion cyst
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Colle’s Fracture
Involves the distal end of radius
Deformity
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Mechanism of Injury
• Fall on an outstretched hand
• Run into wall, etc, with wrist hyperextended
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S/S – Signs and Symptoms
• Visible deformity
• Swelling
• Pain
• POT - point tender
• Wrist is bent like a fork
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Care
• Splint in position you
find it
• Ice
• Emergency room
• 1-2 month recovery
time
YOU
DOCTOR
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Wrist Sprain
• Mechanism of Injury:
– Abnormal forced movement of the wrist
– Falling on hyperextended or hyperflexed wrist
– Violent torsion
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Wrist Sprain
• Signs and Symptoms:
– Pain
– Point tenderness
– Swelling
– Difficulty moving wrist
—limited ROM
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Wrist Sprain
• Treatment:
– RICE for mild/ moderate
– Physician referral to rule out fractures for severe
– Splint if necessary
– Exercises for strengthening and ROM (range of motion)
– Tape for support
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Treatment for wrist injuries
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Wrist Tendonitis• Mechanism of injury: repetitive motion at wrist—
usually in flexion/extension
– Seen more often in athletes involved in sports with
repetitive acceleration and deceleration
• i.e. weight lifters, rowers
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Tendonitis
Signs and Symptoms:
• Pain with active motion
• Pain with passive stretching
• Point tenderness over either flexor or extensor
tendons
• Swelling
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Tendonitis
Treatment:
• Ice
• Heat
• Pain medications – Panadol, ibuprophen
• Modify activity
• Splint
• Strengthening and ROM exercises
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Ganglion Cyst
• herniation of joint capsule, synovial sheath of
tendon or cystic structure
Mechanism of injury:
• Appears slowly after repeated forced
hyperextension of wrist.
– Contains clear mucous fluid
– Appears most often on dorsum of hand
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Ganglion cystS/S:
• pain on dorsum of hand that increases with
wrist extension
• May feel soft and rubbery or hard
• May appear bigger with flexion of wrist
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Ganglion Cyst
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Ganglion cyst
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Ganglion Cyst
Treatment:
• Break down swelling with digital pressure and
padding
• Aspiration and chemical cauterization followed
by pressure padding
• Will usually come back
• Surgical removal
• HIT IT WITH A BOOK
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Hand injuries
• Dislocation of lunate
• Scaphoid Fracture
• Hamate Fracture
• Metacarpal Fracture—Boxer’s fracture
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Dislocation of Lunate
Mechanism of Injury:
– Forced hyperextension of wrist
S/S:
– Pain
– Swelling
– Difficulty moving wrist and fingers into flexion
– Numbness/paralysis of flexors due to pressure of
lunate on median nerve
– deformity
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Lunate dislocation
• Treatment:
– Splint
– Ice
– Physician referral for
reduction
– 1-2 month recovery
time
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Lunate Dislocation
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Scaphoid Fracture
• Mechanism of Injury:
– Fall on hyperextended wrist
– Force on outstretched hand (hyperextended wrist)
that compresses the bone between the radius and 2nd
row of carpal bones
• S/S:
– Pain and Point tenderness over the anatomical snuffbox
– Swelling
– Possible discoloration
– Loss of motion
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Scaphoid fracture
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Scaphoid Fracture
• Treatment:
• Ice
• Splint
• Physician referral
• Initial immobilization for 6 weeks
• If not recognized as fracture, could have non-
union then surgery is required
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Hamate Fracture
• Mechanism of Injury:
– Fall on hand
– Contact to palm of hand with sports implement
• Swinging baseball bat
• Swinging tennis racquet
• Swinging golf club
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Hamate fracture
• S/S:
– Wrist pain
– Weakness in wrist
motion
– Point tenderness over
hook of hamate
– Possible tingling,
numbness due to
compromise of ulnar
nerve
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Hook of hamate fracture
• Treatment:
– Ice
– Splint
– Physician referral
– cast
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Metacarpal (Boxer’s) Fracture
• Most common of all metacarpal fractures
• Associated with martial arts/boxing
• MXN:
• direct axial force caused by punching another
person or object
• Direct impact to hand
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Boxer’s fracture
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Boxer’s Fracture• S/S:
• Point tenderness over the
metacarpal involved
• Palpable defect in the shaft
of the 5th metacarpal (or
other metacarpals)
• Swelling
• Discloration
• Pain with movement
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Boxer’s fracture
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Boxer’s (Metacarpal) Fracture
• Treatment:
• Ice
• Splint
• Physician referral for
x-ray
• Reduction and casting
(3-4 weeks)
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Finger Injuries
• Mallet Finger
• Jersey Finger
• Gamekeeper’s Thumb
• Sprain
• Subungual hematoma
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Mallet Finger
Mechanism of Injury :
• Blow to tip of finger,
jamming it and tearing
of extensor tendon at
the distal phalanx
• Can cause fracture as
well
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Mallet Finger
S/S:
• Pain
• Point tenderness of distal phalanx
• Deformity
• Unable to extend finger at DIP joint
• Detached bone may be palpable
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Treatment:
• RICE
• Splint into extension 6-8 weeks
• Physician referral
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Mallet finger
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Jersey Finger
Mechanism of Injury:
• Forced extension/hyperextension of DIP joint
• Grabbing on to a jersey
• Rupture of flexor digitorum profundus tendon
and or tearing fracture
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Jersey Finger
S/S:
• Point tenderness of DIP joint
• DIP joint cannot flex
• Finger is in extended position
• Pain
• Swelling
• discoloration
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Jersey Finger
Treatment:
• Ice
• Splint
• Physician referral
• Surgery to repair tear
• 12 week recovery
• May have weakness with motion due to poor gliding motion of tendon
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Gamekeeper’s Thumb
Mechanism of Injury:
• Forced abduction and hyperextension of the
proximal phalange of thumb
• Falling on the thumb
• Sprains UCL of 1st MP joint
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Gamekeeper’s Thumb
S/S:
• Pain
• POT over UCL of thumb
• Swelling
• Discoloration
• Instability of joint
• Unable to grip
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Gamekeeper’s Thumb
Treatment:
• Ice
• Splint
• Physician referral for
x-ray to rule out
tearing fracture
• Possible surgery
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Finger Sprain
MXN – Mechanism of Injury:
• Axial (twisting) force to the tip of the finger, “jamming” it
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Finger Sprain
S/S:
• Pain
• Point tenderness
over the collateral
ligaments
• Swelling
• Discoloration
• Joint instability
Treatment:
• Ice
• Splint
• Physician referral if
necessary for x-rays
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Subungual Hematoma
• Mechanism of Injury: direct blow to the
fingernail
• S/S: throbbing pain due to accumulation of
blood under the nail
• Treatment: ice (water) to numb, release pressure
under nail by drilling/burning a hole it the nail
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Ring injury
• Mechanism of Injury: getting ring/jewelry
caught on something
• S/S: deformity, bleeding, pain, loss of body part
• Treatment: find body part, control bleeding,
cover open wound, treat for shock, send to ER
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Ring injury