Wrist, Hand, & Fingers Injuries

Mallet Finger

"Jammed finger"; cannot actively extend DIP; splint distal phalanx in hyperextension 6-8 weeks

Scaphoid Fracture

Anatomical Snuff box, often missed, high rate of nonunion - AVASCULAR NECROSIS; little swelling, thumb splint

Ganglion Cyst

Appears on dorsum of hand; increases in size & pressure w/ use, benign; herniation of joint capsule

Volar Plate Injuries

Avulsion Fx's; joint instability in ext; fx > 40% of articular surface - surgery

Metacarpal Fx's

Axial load along bone shaft, snap, immediate pain & swelling, PT, +/- swelling, cast or splint 3-4 weeks

Acute Paronychia

Bacterial or funal infection of nail bed; direct or indirect trauma

Stenar's Lesion

Complete UCL rupture w/ interposition of add. poll. aponeurosis; 80%, prevents healing, needs surgical repair

Carpal Tunnel Syndrome

Compression of Median Nerve as it passes thru tunnel; tenosynovitis of flex tendons; poor ergonomics; paresthesia from 1st - 3rd, increase @ night

Distal Phalanx Fx

Crush, compression, rotation Mx; often presents w/ subungual hematoma

Boutonniere Deformity

DIP in ext, PIP in flexion; ext tendon slips on each side of PIP, changes line of pull; swelling, +/- deformity, splint 6-8 weeks

Tendinosis

Degradation of tendon

Colles Fracture

Distal radius fx, "dinner fork" deformity, dorsal displacement; FOOSH; splint, ER, immobilize 4-6 weeks

Smith's Fracture

Fall on flexed wrist - volarly displaced wrist, adult fx (16+ yo); broken below growth plate

Boxer's Fracture

Fracture of 4th &/or 5th MC, localized swelling, cast MCP in flexion

Bennett's Fx

Fx of base of 1st MC; axial load to partially flexed MC, often needs ORIF

Wrist Sprains/Strains

General pain & diffuse tenderness, rule out fx, decreased ROM, +/- swelling

Hook of Hamate Fx

Impact on hypothenar eminence, knocks off little piece, PT tender, AVN, long heal time, not common

Phalen Sign

Indicative of CTS, wrists flexed against each other; problem if TOS suspected

FELON

Infection of the pad of the finger

Tenosynovitis

Inflammation of sheath around tendon

Tendinitis

Inflammation of tendon

Wrist Dislocations

Infrequent, usually w/ hyperextension; lunate most common

Proximal Phalanx Fx

Intra-articular Fx's of PIP; 25% + joint surface involved, consider fixation; non-displaced, RTP 2-4 weeks

Middle Phalanx Fx

Less common, RTP 7-10 days

Shaft Fx's

Most are stable, snap, pain, +/- deformity, dec ROM, fx proximal to rotation

Coaches Finger

Neglected PIP or DIP injury, 3-4 months w/ pain & stiffness

MCP Dislocation

Not common, but most common in thumb; volar plate ruptures proximally; Bennett's fx more common

PIP Dorsal Dislocation

Obvious deformity, distal end on top, +/- underly fx's, volar plate injury

ORIF

Open Reduction Internal Fixation

Keinbock's Disease

Osteochondritis of lunate

PIP Dorsal Dislocation Reduction

Pull up w/ wrist flexed, THEN pull traction

Collateral Ligament Injuries

Rad or Uln stress test on finger in slight flexion; Grade I or II - splint, buddy tape; Grade III - tx controversial

PIP Volar Dislocations

Rare

Trigger Finger

Repeated motions produces tenosynovitis; inflammation of tendon sheath - more common in flexor tendons; forms a nodule so finger gets stuck - "triggering"

Jersey Finger

Rupture of flex dig profundus from DIP; caught in a shirt; pain, tenderness, little swelling, RTP 5 weeks in splint

Distal Phalanx Contusion

SUBUNGUAL HEMATOMA; if fx, do not aspirate - open fx!

Gamekeeper's Thumb

Sprain of UCL of thumb, forced hyperabduction or hyperextension, assoc. w/ avulsion fx; limits opposition; Grade II - surgery

DeQuervain's Syndrome

Tenosynovitis of EPB & ABPL - Tunnel I; repetitive stress, crepitus, + Finkelstein Test

Finkelstein Test

Thumb in fist, ulnarly deviate for tension - PAIN

Lunate/Perilunate Dislocation

Ulnar sided pain, possible paresthesia of ulnar nerve (4&5), point tender, bulge visible, maybe assoc. w/ scaphoid fx

Finger Fx's

X-ray only real way to know; difficult to distinguish from sprains