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