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