Wrist/Hand Sports med 2

Articulations Radiocarpal Carpal Metacarpal Phalangeal Flexion, extension, abduction, and circumduction Carpal Gliding joints Stabilized by anterior, posterior, and connecting ligaments Metacarpal Flexion, extension, abduction, adduction, circumduction Phalangeal Hinge joints Proximal interphalangeal (PIP), Distal interphalangeal (DIP)

Ligaments Wrist Phalanges Ulnar Collateral ligament Ulna to pisiform Radial collateral ligament Radius to scaphoid Transverse carpal ligament Roof of the “carpal tunnel” Phalanges Collateral ligaments

Muscles Flexors Extensors Intrinsics Palmar surface Flexor digitorum superficialis, flexor digitorum profundus Extensors Dorsal surface Extensor digitorum longus, Intrinsics Abduction and adduction

Blood/Nerve Supply Nerves Arteries Ulnar, radial Median Radial ulnar Enters palm through carpal tunnel Arteries Radial ulnar

Assessment History MOI Location and type of pain? Increases or decreases pain? History of trauma or overuse? Any therapy given in the past?

Assessment Observations Hand usage like writing, unbuttoning shirt Open and close hand Fully? Rythmically? Touch thumb to each fingertip Flat knuckle Color of fingernails Pale= poor circulation

Assessment Palpations Bony Soft Scaphoid (anatomical snuffbox) Lunate Hamate (hook) Metacarpals Phalanges (proximal, middle, and distal) Soft Triangular fibrocartilage (TFCC) Collateral ligaments of phalanges Flexor and extensor muscles Use hand flashcards for palpation practice

MMTs Flexion Extension Ulnar deviation Radial Deviation 5th digit moves towards ulna Radial Deviation Thumb moves towards radius Finger Abduction Fingers spread out Finger Adduction Fingers back together Perform Active, passive, resistive of all movements on ALL fingers

Tenosynovitis MOI S/S TX Repetitive use and overuse of tendons and their sheaths S/S Pn with use, pn w/passive stretching Tenderness, swelling over tendon TX Ice massage, NSAIDS, rest ROM, contrast baths, US, PRE

Carpal Tunnel Syndrome MOI Inflammation in the carpal tunnel, compresses median nerve Repeated flexion, or direct blow S/S Tingling, numbness, weakness TX Rest, immobilization, NSAIDS Possible surgery

Finkelsteins Test tests for de Quervain’s disease http://youtu.be/lXV_UV62USc Procedure Athlete is sitting, forms a fist around the thumb. Examiner grasps the athlete's forearm and fist and ulnarly deviates Positive Test Pn. = Possible tenosynovitis (de Quervain’s disease) Pn. At carpal tunnel = carpal tunnel syndrome

Phalens Test Procedure Positive Test http://youtu.be/DZ9UGuA8oAE Procedure Have athlete flex both wrists as far as possible and press together for 1 minute Positive Test Pn. At the carpal tunnel = carpal tunnel syndrome

Wrist Sprains (most common) MOI Falling on hyperextended wrist Violent flexion or torsion S/S Pn, swelling, decreased AROM TX RICE, splinting, analgesics Tape, strengthening

Gamekeepers Thumb MOI (skiiers, tacklers) S/S TX Sprain of UCL ligament of MCP joint of thumb Forceful abduction with hyperextension S/S Pn, weak pinch, Tenderness and swelling TX Refer Splint 3 weeks

Glide Test Procedure Positive Test http://youtu.be/YrJ98IYsgBw Procedure Grasp the athletes wrist with one hand and their carpals with the other Move anterior/posterior and radial/ulnar directions Can also do on each phalange/metacarpal joint Positive Test Pn./laxity = sprain

Valgus/Varus Procedure Positive Test Examiner maintains stabilization of the proximal bone between the thumb and forefinger and grasps the distal bone Examiner provides a valgus/varus force Positive Test Pn./laxity = collateral ligament tear/sprain

Triangular Fibrocartilage Complex Injury (TFCC) MOI Forced hyperextension S/S Pn along the ulnar side of wrist Extension = pn, difficulty Swelling later on TX refer

Scaphoid Fx (most common) MOI FOOSHA, compresses scaphoid between radius and carpals S/S Point tenderness in snuff box Pn. With thumb compression and radial flexion TX Splint and refer for x-ray Untreated leads to necrosis

Hamate (hook) Fx MOI S/S TX Direct blow from racket, bat, sports stick, club S/S Wrist pn and weakness Point tender TX Refer for x-ray Doughnut pad

Colles Fx MOI S/S TX Fx to distal end of radius or ulna FOOSHA, or hyperextension S/S Visible deformity Swelling and pn TX Ice and splint refer

Boxers (5th metacarpal) Fx MOI Direct axial force (punching) Getting stepped on S/S Pn and swelling TX RICE, analgesics, refer Splint 4 weeks, early ROM

Compression Test Procedure Positive Test Athlete has finger extended Examiner holds the distal phalanx and applies compression along the axis of the bone of the finger being tested Can also be done on metacarpal in fist position Positive Test Pn at injury site = possible fx

Allens Test Procedure Positive Test http://youtu.be/jq0ai5uXx68 Procedure Athlete squeezes hand into a fist and fully opens hand 3-4 times With athlete holding the last fist the evaluator puts pressure over radial and ulnar artery Athlete opens hand (appears white), evaluator releases 1 artery and the hand should become red Positive Test Not turning red instantly = radial or ulnar artery compromise

Mallet Finger MOI S/S TX Direct blow to extended finger Pn at DIP unable to extend finger TX RICE Splinted 24 hr/day, 6-8 weeks

Boutonniere Deformity MOI Trauma forcing the DIP into extension and PIP into flexion S/S Pn and inability to extend the DIP Swelling, obvious deformity TX Ice Splint PIP in extension5-8 weeks Flex distal phalanx

Jersey Finger MOI S/S TX Most often in the ring finger Grabs a jersey, ruptures flexor tendon S/S DIP joint cant be flexed Finger stuck in extension TX No surgery = never flex DIP again Surgery = 12 weeks of rehab

Tap/Percussion Test Procedure Positive Test Athlete extends affected finger Evaluator applies a firm tap to the end of the finger Positive Test Pn. At injury site = possible fx