Wrist and Hand Chapter 18 May 2006

Anatomy Bones Carpal Bones are irregular shaped bones that articulate between the radius and ulna of the arm and the metacarpals of the hand to allow wrist movement. - Trapezium, Trapezoid, Scaphoid, Lunate, Triquetral, Pisiform, Capitate, Hamate. - The Scaphoid bone only has blood supply on one end, making it difficult for the bone to heal when fractured. Metacarpal Bones are numbered one through five beginning with the thumb side of the hand. The fingers have a total of 14 Phalanges: Five Proximal Phalanges, four Middle Phalanges, and five Distal Phalanges. The “Anatomical Snuffbox” is a depression at the wrist where the Scaphoid bone sits.

Anatomy Con’t Joints Carpometacarpal Joints are the five joints between the carpal bones and the metacarpal bones. Metacarpal phalangeal (MCP) joints are the joints between the metacarpal bones and the proximal phalanges. Proximal interphalangeal (PIP) joints are the joints between the proximal phalanges and the middle phalanges. Distal interphalangeal (DIP) joints are between the middle phalanges and the distal phalanges. Muscles Wrist and Hand movement is controlled by many different muscles. The Flexor muscle group is found on the anterior surface of the forearm, and the Extensor muscles are located on the posterior aspect of the forearm.

Preventing Wrist and Hand Injuries Use protective equipment for the wrist and hand, including braces, tape, gloves, and padding. Athletic trainers can use plastic splints and braces to prevent injury for someone who may be susceptible. Use proper playing techniques that prevent hand and wrist injuries.

Ligament Injuries Ligament injuries, in many cases, are not serious and can be treated with PRICE. The common misconception that sprains must be “pulled back into place” is not true! It can only cause more damage to the wrist. Wrist Sprain - Occur from overuse, falls, and forceful twisting motion. Excessive amount of ulnar deviation will injure the ligament on the radial side, and excessive radial deviation will injure the ligament on the medial side. - Athlete will experience pain, swelling, decreased ROM, and decreased grip strength. - Treat with PRICE. Athlete should focus on reestablishing normal ROM. Dislocation of the Lunate - Occurs when an athlete falls upon his hand while in flexion or extension at the time of impact. - It will cause deformity, pain, swelling, and decreased ROM. - The dislocation should be splinted and referred to a physician.

Ligament Injuries Con’t Gamekeeper’s Thumb - Gamekeeper’s thumb is an injury to the medial collateral ligament; The Medial collateral lig. Is forcefully abducted. The term was used to describe the farmer who injured his medial collateral lig. When breaking the necks of birds intended for the cooking pots. Its also called the “Skier’s thumb” because of how the ski pole forces the thumb into abduction. - Athlete will experience pain, and swelling. - Treat by splinting the medial aspect of the thumb and by icing. Refer to a physician for an X ray. Interphalangeal Collateral Lig. Sprains - Occurs when the joint is stressed beyond normal and the ligament are over extended. It forces too much stress on the ligament causing it to become sprained. - Athlete will experience pain, swelling, and discoloration. The athlete’s hand will be partially disabled. - Treat with PRICE. Buddy taping and padding will help to prevent further injury.

Dislocation of the Lunate

Ligament Injuries Con’t Dislocation of the Interphalangeal Joint or Metacarpal Phalangeal Joint - When a dislocation of the IP and MCP joint occurs, one bone usually moves dorsal and one volar, causing a dislocation. - The team physician should relocate all dislocated fingers and thumbs because tiny tendons, nerves, and blood vessels can course their way through joint spaces. But relocating the fingers improperly can cause permanent damage to that finger.

Muscle and Tendon Injuries Repetitive stress and stretching will cause the muscles to strain. Pain, swelling, weakness, and inability to move are common symptoms and signs. The Athletic Trainer will use ROM testing to determine which muscle has been affected. Tendinitis (inflammation of the Tendon) - Caused by overuse, stretching, or an impact. - The ATC’s goal is to prevent Tendinitis by increasing strength and flexibility, by using padding, and by avoiding repetitive injuries. - De Quervain’s tendinitis affects the abductor pollicis longus and extensor pollicis brevis. Athlete will have difficulty with abduction of the thumb, and may experience swelling and crepitus. - Treat with PRICE. Boutonniere Deformity - Occurs at the proximal interphalangeal joint. Caused by a hard impact over PIP joint, causing a tear in the joint capsule. When the tendons are in lateral position, they contract and force flexion of the DIP joint. - Athlete will experience pain and swelling. - ATC will splint the finger and refer the athlete to a physician for treatment.

Muscle and Tendon Injuries Mallet Finger - A result of the fingertip receiving an impact. The impact causes the extensor tendon to be torn from the bone. - Athlete will experience pain, and some swelling. - The finger should be splinted into extension and referred to a physician for care. The physician could treat it surgically or keep it splinted. Jersey Finger - Similar to Mallet finger except that the flexor tendon tears from the fingertip. Occurs when the DIP joint is forcibly flexed. - Athlete will experience pain and swelling. - Treat with splinting and ice. The finger will need an X ray to determine the extent of the injury.

Mallet Finger

Bone Injuries Any bones within the wrist and the hand can fracture. Direct impacts are the most common cause of the fractures. Swelling, pain and deformity, and disability are common with fractures. Avascular Necrosis is death to the bone due to lack of blood flow. In the wrist, the Scaphoid bone is the most common to be associated with nonunion and avascular necrosis. All fractures should be cared for by splinting and should be evaluated by a physician.