Hand
wrist account for up to
9% of all sport-related injuries
Bone Injuries
Any bone can fracture
Muscle and Tendon Injuries MOI
Any of the numerous muscles of wrist and hand can be strained by repetitive stress and stretching
Smith's Fracture MOI
Arm bent inward
Bone Injuries Complications
Avascular necrosis (Death of bone due to lack of blood supply) Nonunion of bone Most common in scaphoid bone
Dislocation of Interphalangeal of Metacarpophalangeal Joint
Bone usually moves dorsal and one moves volar (toward palm)
Jersey Finger S/S
Cannot flex DIP Pain Swelling
Boutonniere Deformity at PIP joint S/S
Cannot straighten PIP joint Pain swelling
Interphalangeal Collateral Ligament Sprain
Collateral ligament located on side of each interphalangeal joint ligament provides stability when phalanges are stressed
Wrist Sprain MOI
Commonly occur from overuse falls or forceful twisting motion Which ligament is injured depends on stress → excessive amount of ulnar deviation at wrist will injure ligament on radial side
Dislocation of Lunate Bone S/S
Deformity Pain Swelling Decreased ROM
Tendinitis TX
Difficult to overcome Goal is to prevent by increasing strength and flexibility Using padding Avoiding repetitive movements
De Quervain's Tendinitis - of thumb S/S
Difficulty with thumb abduction Swelling Crepitus
Bone Injuries MOI
Direct impacts most frequent
De Quervain's Tendinitis - of thumb
Effects abductors and pollicis longus and extensor pollicis brevis
Dislocation of Lunate Bone MOI
Falls on hand (flexion or extension) most common the lunate
Interphalangeal Collateral Ligament Sprain MOI
Finger hit by ball athlete lands with fingers curles of extended or if finger is caught an opponent's jersey
Mallet Finger S/S
Fingertip is in flexion Cannot lift tip of finger to straighten bone because tendon is no longer attached Swelling pain
Mallet Finger MOI
Fingertip receiving impact causing extensor tendon to tear from bone
Jersey Finger MOI
Flexor tendon tears from fingertip (forcibly flexed) Hanging onto jersey in fist and finger is forced to extend
Triangular Fibrocartilage Injury (TFCC) MOI
Forceful rotation or hyperextension of wrist
Boxer's Fracture
Fracture in metacarpal region Specifically 4th and 5th metacarpal *common)
Boutonniere Deformity at PIP joint MOI
Hard impact causing tear in joint capsule allowing extensor tendons to fall laterally
Boxer's Fracture can occur as
Head fracture Neck fracture Shaft fracture Base fracture
Triangular Fibrocartilage Injury (TFCC) TX
Immobilization followed by rehab plan to restore ROM and strength Possibly surgery
Tendinitis
Inflammation of tendon
Triangular Fibrocartilage Injury (TFCC)
Injury has been seen as a problem in athletes who sprain wrist Piece of cartilage located between ulna and carpal bones and it plays a role in cushioning these structures
Gamekeeper's Thumb
Injury to medial collateral ligament of thumb also know as skier's thumb First used to describe farmers who injured ligament when killing birds Skier's thumb into abduction
Radial Collateral ligament
Lateral collateral ligament located on lateral aspect
Ligament Injuries
Many sprains not serious treats with PRICES Common misconception about sprains is that they must be pulled back into place Pulling on injuries ligaments can cause more damage
Ulnar collateral ligament (of thumb)
Medial collateral ligament located on medial aspect
Nerve Injury
Most common injury to median nerve that runs anterior to the carpal bones Carpal bones form tunnel along with overlying ligamentous tissue Medial nerve travels through tunnel into nerve
Ganglion Cyst MOI
Not known One theory → trauma causes tissue of joint to break down causing tissue break down forming small cysts that grow into big wrist
Colle's Fracture
Occurs to distal forearm Both radius and ulna fracture
Smith's Fracture
Occurs to distal forearm Both radius and ulna fracture
Ganglion Cyst TX
Often clears on its own Can be drained or removed
Tendinitis MOI
Overuse Stretching Impact
Nerve Injury MOI
Overuse from gripping typing or any other repetitive movements the nerve will be compressed
De Quervain's Tendinitis - of thumb TX
PRICES Rest from repetitive motion
Wrist Sprain TX
PRICES Tape Reestablish ROM and strength
Triangular Fibrocartilage Injury (TFCC) S/S
Pain Swelling Reduced ROM and strength
Muscle and Tendon Injuries S/S
Pain Swelling Weakness Inability to move
Tendinitis S/S
Pain Swelling Weakness Inability to move
Nerve Injury S/S
Pain Tingling Numbness Weakness in thumb index finger and digit of hand
Wrist Sprain S/S
Pain decreased ROM decreased grip strength some swelling
Gamekeeper's Thumb S/S
Pain over joint Swelling
Interphalangeal Collateral Ligament Sprain S/S
Painful and disabling Swelling and discolored
Preventing wrist and hand injuries
Protective equipment Protective taping padding
Boxer's Fracture MOI
Punching or hitting object hard
Colle's Fracture MOI
Reaches hand out to catch fall most arm bent into extension
Dislocation of Interphalangeal of Metacarpophalangeal Joint TX
Relocate ASAP by physician due to tiny tendons nerves and blood vessels If done incorrectly there can be permanent damage to finger May be ligament tear possible avulsion fracture
Ganglion Cyst S/S
Round small and painless Rare can be painful cyst can interfere with joint movement
Dislocation of Interphalangeal of Metacarpophalangeal Joint MOI
Softball player diving for ball
Boutonniere Deformity at PIP joint TX
Splint Refer to physician Splint long term to allow healing of connective tissue that keeps extensor tendons in place Surgery if needed
Mallet Finger TX
Splinted into extension Referred to physician Splinted tendon may heal back to bone May need surgery Without treatment → permanent flexion of DIP joint
Bone Injuries TX
Splinting Referral to physician
Jersey Finger TX
Splinting and ice Refer to physician → extended splinting or surgery
Dislocation of Lunate Bone TX
Splinting and referred to physician x-rays
Gamekeeper's Thumb TX
Splinting medial aspect of thumb and icing x-ray to determine if there is an avulsion
Dislocation of Interphalangeal of Metacarpophalangeal Joint S/S
Swelling Deformity Pain
Bone Injuries S/S
Swelling Pain Deformity Loss of motion
Gamekeeper's Thumb MOI
Thumb forced into abduction (catching a basketball)
Nerve Injury TX
Wrist splint stretching flexor muscles of the wrist and medication If needed → injection of steroid surgical procedure to open space
Interphalangeal Collateral Ligament Sprain TX
X-ray to rule out fracture Ice Buddy tape
De Quervain's Tendinitis - of thumb common in
shot-putters who hold shot while wrist is in radial deviation