Injuries to the Wrist, Hand, and Fingers

Anatomy- Wrist Anatomy of the wrist is very complex Movements 8 small bones Muscles/tendons Ligaments Nerves/arteries/veins Retinaculum Movements Flexion/extension Ulnar deviation/radial deviation Pronation/supination

Injuries to the Wrist Injuries to the wrist are fairly common in all sports A variety of injuries can happen to this area Most common MOI is forced extension Injuries to this area are hard to diagnose

Forearm Fractures Very common MOI Signs and Symptoms Treatment Falling on an outstretched hand Direct trauma Signs and Symptoms Popping/snapping sound Pain that is made worse with movement Unable or unwilling to move wrist Obvious/palpable deformity Treatment Splint and send for imaging RICE Be sure to monitor vital signs

Wrist Fractures- Scaphoid Common in all sports MOI FOOSH Signs and symptoms May present as a bad sprain Pain/swelling in anatomical snuffbox Treatment Imaging will be necessary Immobilization If not treated properly, complications will arise

Wrist Sprains Very hard to determine exact ligament that is damaged MOI Usually forced extension but can happen in any direction Signs and symptoms Pain in a specific area or with specific movement Laxity when joint is tested Swelling and discoloration Treatment RICE Limited painful activity Rehab exercises to build strength A brace may be necessary

Triangular Fibrocartilage Complex (TFCC) TFCC is a fibrous and cartilaginous structure Major ligamentous stabilizers MOI Violent twist of the wrist FOOSH Signs and Symptoms Not reported immediately Pain on ulnar side Pain with extension Treatment Immobilized for 4 weeks Surgery if conservative treatment fails

Nerve Injuries to the Wrist Major nerves of the wrist include the radial, ulnar and median Most common nerve injured is median Signs and symptoms Pain, numbness, weakness Symptoms will be worse with extreme flexion/extension Treatment Suspected nerve problems should be referred to a physician Surgery is sometimes necessary to fully correct the problem

Unique Injuries to the Wrist Ganglion cyst Herniation of the synovium surrounding the tendons Herniated tissue will fill with synovial fluid and produce a bump Exact cause is unknown but chronic strain of extensor tendons is main idea Signs and symptoms Obvious bump on dorsal side of wrist Painful at first but pain may go away and only be present at certain times Treatment Treatment will depend on size and impairment Surgery or draining Bible cyst?

Anatomy- Hand Very complex 19 bones Muscles Ligaments 5 metacarpals 14 phalanges Muscles Ligaments

Injuries to the Hand and Fingers Injuries to this area are very common in all sports Only a few sports offer protection A variety of injuries are possible Vary in severity as well Fingers are very susceptible to injury Imaging is usually necessary to diagnose Rehabilitation can be very complicated and usually requires a specialist

Hand- Boxer’s Fracture Fracture to the 4th or 5th metacarpal MOI Blow to hand in clenched position Signs and Symptoms Pain and swelling Deformity and discoloration Unable to make a fist Treatment RICE Refer for imaging Cast or splint until fracture heals After cast is removed rehab may be necessary to restore strength

Gamekeeper’s Thumb Injury to the metacarpophalangeal joint in the thumb Sprain- ulnar (medial) collateral ligament Possible avulsion fracture (30%) MOI Extreme abduction of the thumb Signs and symptoms Pain/discoloration Swelling Laxity Treatment Refer to physician for evaluation and imaging Cast Surgery may be necessary depending on severity of injury

Finger Injuries- Mallet Finger Injury to the distal phalanx of the index or middle finger Involves an avulsion of the extensor tendon from the distal interphalangeal joint MOI Blow to tip of finger when it is extending Signs and symptoms Pain/discoloration/swelling Deformity Unable to extend the tip of finger Treatment Splint finger in full extension Possible surgery

Finger Injuries- Jersey Finger Injury to the distal phalanx of the index or middle finger Avulsion of the flexor tendon at the distal interphalangeal joint MOI Pulling of the tip of finger when in a flex position Signs and symptoms Pain/discoloration/swelling Deformity Unable to flex the tip of finger Treatment Surgery is usually necessary Rehab program after surgery

Finger Fractures Quite common in sports Can be a lot more severe than they present Surgery may be necessary to prevent loss of function