1. The Wrist, Hand, & Fingers
John H. Anderson, MS, ATC, LAT
Associate Professor EMERITUS
Athletic Training Program
Troy University
NATA member for OVER 50 years
32nd Student SEATA Meeting
February 25, 2017
Student SEATA Meeting
Atlanta, Georgia

2. Evaluation of Wrist, Fingers, & Hand

3. History Location of Pain Mechanism of Injury Relevant Sounds
Relevant Sensations
Duration of Symptoms
Description of Symptoms

4. Inspection General Area Posture of Hand Gross Deformity Palmar Creases
Areas of Cuts or Scars

5. Inspection Wrist & Hand Thumb & Fingers
Continuity of the Distal Radius & Ulna
Continuity of the Carpals & Metacarpals
Posture
Ganglion Cyst
Thumb & Fingers
Skin
Fingernails
Alignment of Fingernails
Finger Deformities

6. Palpation of the Hand Metacarpals MCP Collateral Ligaments Phalanges
IP Collateral Ligaments
Thenar Compartment
Thenar Webspace
Central Compartment
Hypothenar Compartment

7. Palpation of the Hand Ulna Radius Ulnar Styloid Process
Ulnar Collateral Ligament
Radius
Radial Styloid Process
Radial Collateral Ligament
Lister’s Tubercle

8. Palpation of the Carpals
Scaphoid
Trapezium
Lunate
Pisiform
Hamate
Capitate
Trapezoid

9. Range of Motion Tests Wrist AROM PROM RROM Flexion Extension
Radial Deviation
Ulnar Deviation

10. Range of Motion Tests Thumb CMC AROM PROM RROM Flexion Extension
Abduction
Adduction
Opposition

11. Range of Motion Tests Fingers AROM PROM RROM Flexion & Extension – MCP
Abduction & Adduction – MCP
Flexion & Extension – IP Joints

12. Ligamentous Tests Valgus & Varus Stress Testing - Radiocarpal Joint
Glide Testing of Wrist
Valgus & Varus Testing – IP Joints
Ulnar Collateral Ligament - Thumb

13. Neurological Testing
Radial Nerve
Median Nerve
Ulnar Nerve

14. Special Tests Carpal Tunnel Syndrome DeQuervain’s Syndrome
Phalen’s Test
DeQuervain’s Syndrome
Finkelstein Test

15. Other Special Tests Others Tap or Percussion Test Compression Test
Long Finger Flexor Test
Tinel Test
Wrinkle or Shrivel Test
Digital Allen Test
Bunnel Littler Test
Watson Test

16. Signs
Murphy’s Sign
Froment’s Sign

17. General First Aid of Wrist & Hand Injuries

18. First Aid Care Ice Splint Position of Function Sling
Soft, Inflated, or Rigid
Position of Function
Wrist
Fingers
Sling

19. Injuries to Wrist & Hand

20. Wrist Strain Mechanisms Symptoms Signs Special Tests
Trauma to musculotendinous unit, due to forcible contraction or stretching, and muscle fatigue
Symptoms
Pain increased with AROM & passive stretch; loss of function; possible snapping sound upon injury; muscle fatigue prior to injury; pain on RROM; tenderness
Signs
Muscle spasm; swelling; ecchymosis; point tenderness; loss of function & strength; hematome formation; defect in musculotendinous unit with third-degree injury; inflammation; possible Ca formation with third-degree injury
Special Tests
AROM, RROM, & passive stretch
Referral and Diagnostic Procedures
Orthopedist is persistent S/S
Classification of Injury
First-, second-, third-degree strain

21. Wrist Luxation Common Term – Dislocated Wrist Mechanisms Symptoms
Direct trauma causing hyperextension of wrist
Symptoms
Pain & loss of function
Signs
Marked deformity; loss of function; swelling; point tenderness
Referral and Diagnostic Procedures
Orthopedist; X-Ray for possible fracture

22. Wrist Ganglion Common Term – Bible Cyst Mechanisms Symptoms Signs
Herniation resulting from minor dorsal or volar capsule sprains of joint capsule through process of mucoid degeneration or herniation of synovial sheath of the flexor carpi radialis tendon sheath, digital extensors, and roof of the first dorsal compartment
Symptoms
Pain; loss of function; discomfort on use of hand & wrist
Signs
Appears slowly after injury as a bump on back of wrist. It may appear, then disappear, then reappear.
Referral and Diagnostic Procedures
Orthopedist; MRI

23. Colles’ Fracture Common Term – Broken Wrist Mechanisms Symptoms Signs
Indirect or direct trauma to the distal forearm by falling on an outstretched hand or hyperextended wrist fracturing the distal end of the radius & ulna
Symptoms
Sudden pain; los of function; direct & indirect tenderness
Signs
Loss of function; possible deformity; rapid swelling; direct &/or indirect tenderness; possible bony deviation, crepitus, or false motion; delayed ecchymosis; possible median nerve damage
Referral and Diagnostic Procedures
Orthopedist; X-Ray

24. Carpal Fracture Mechanism – Direct trauma Symptoms Signs
Sudden pain; loss of function; direct or indirect tenderness
Signs
Loss of function; possible deformity; rapid swelling; direct or indirect tenderness; possible tenderness, crepitus, & false motion; delayed ecchymosis
Referral and Diagnostic Procedures
Orthopedist; X-Ray

25. Tenosynovitis Mechanisms Symptoms Signs Special Tests
Overuse; direct trauma; repetitive trauma
Symptoms
Pain on AROM and RROM; pain on passive stretch; loss of function
Signs
Swelling; thickened tendon in chronic cases; snowball crepitus; inflammation
Special Tests
AROM; RROM; passive stretch
Referral and Diagnostic Procedures
Orthopedist if s/s persist

26. Carpal Tunnel Syndrome
Mechanisms
Compression of median nerve as it passes beneath the flexor retinaculum on the volar aspect of the wrist
Symptoms
Numbness & tingling in fingers; pain; loss of function
Signs
Point tenderness at wrist; pain over carpal tunnel; poor finger flexion
Special Tests
Tinel’s sign; Phalen’s test; Electromyography; nerve conduction study
Referral and Diagnostic Procedures
Orthopedist; X-Ray

27. Lunate Luxation Common Term – Dislocated Carpal Bone Mechanisms
Indirect trauma; fall on outstretched hand or hyperextended wrist
Symptoms
Pain; loss of function; numbness of flexor muscles due to pressure on median nerve; tenderness
Signs
Marked deformity; loss of function; swelling; point tenderness; Murphy’s sign
Referral and Diagnostic Procedures
Orthopedist; X-Ray for possible fracture

28. Navicular (scaphoid) Fracture
Mechanisms
Indirect trauma to an outstretched hand (thumb) or hyperextended wrist
Symptoms
Sudden pain; loss of function; direct & indirect tenderness
Signs
Loss of function; rapid swelling; direct tenderness to anatomic snuffbox; indirect tenderness; possible bony deviation, crepitus, & false motion; delayed ecchymosis
Special Tests
Compress of thumb; pressure into anatomic snuffbox
Referral and Diagnostic Procedures
Orthopedist; X-Ray

29. Ulnar Collateral Ligament Sprain - Thumb
Common Terms
Gamekeeper’s Thumb or Skier’s Thumb
Mechanisms
Forced abduction & hyperextension of thumb causing sprain of the ulnar collateral ligament
Symptoms
Pain on AROM, RROM, & passive stress; loss of function; tenderness
Signs
Point tenderness over ulnar collateral ligament; swelling; hemorrhage; possible deformity with third-degree injury; ecchymosis; possible instability with second- and third-degree injuries; inflammation
Special Tests
Abduction stress test of thumb
Referral and Diagnostic Procedures
Orthopedist; X-Ray for possible avulsion fracture of ligament
Classification of Injury
First-, second-, third-degree

30. Bowler’s Hand Common Term – Bowler’s Thumb Mechanisms Symptoms Signs
Overuse of the thumb, such as in the hole of a bowling ball, causing pressure on the ulnar nerve
Symptoms
Numbness; pain; tingling
Signs
Loss of sensation of thumb; loss of strength
Referral and Diagnostic Procedures
Neurologist is s/s persist

31. DeQuervain’s Disease Common Term Mechanisms Symptoms Signs
Tenosynovitis of Wrist
Mechanisms
Extensive wrist motion, as in gripping sports, to the abductor pollicis longus & extensor pollicis brevis tendons & their sheaths at the radial styloid; excessive radial or ulnar deviation; combination of these movements
Symptoms
Aching; radiating pains into hand & forearm; loss of strength; pain; inability to grip; point tenderness
Signs
Painful crepitus of the tendon at the base of the thumb; weakness of thumb extension & abduction; parathesia over the dorsum of the thumb; weakness in ulnar deviation; inflammation; possible stenosis of the fibro-osseous canal; possible localized swelling
Special Test – Finkelstein’s Test
Referral and Diagnostic Procedures
Orthopedist if s/s persist

32. Bennett’s Fracture Mechanisms Symptoms Signs
Indirect trauma, such as striking an object with a closed fist on the first metacarpal
Symptoms
Sudden pain; loss of function; direct or indirect tenderness
Signs
Loss of function; possible deformity; rapid swelling; direct tenderness at the base of first metacarpal; indirect tenderness; possible bony deviation, crepitus, & false motion; delayed ecchymosis; “click” felt as joint subluxes
Referral and Diagnostic Procedures
Orthopedist; X-Ray

33. Ulnar Neuropathy Common Terms Mechanisms Symptoms Signs
Handlebar or Cycle Palsy
Mechanisms
Irritation of ulnar nerve caused by abnormal pressure on the hands due to excessive body weight forced forward while the wrists are in prolonged extension; pressure on hypothenar eminence & road vibration during cycling
Symptoms
Loss of strength; pain when riding; pain at rest; decrease in skin sensitivity; sharp burning pain
Signs
Weakness of motor function; minimal sensory findings; loss of coordination of ulnar nerve in fourth & fifth finger
Special Test – Ulnar Nerve Motor Test
Referral and Diagnostic Procedures
Neurologist; EMG study

34. Hamate Fracture Mechanisms Symptoms Signs
Indirect trauma to wrist; fall on outstretched or hyperextended wrist
Symptoms
Sudden pain; loss of function; direct & indirect tenderness
Signs
Loss of function; possible deformity; rapid swelling; direct & indirect tenderness; possible bony deviation, crepitus, & false motion; delayed ecchymosis
Referral and Diagnostic Procedures
Orthopedist; X-Ray; CT Scan

35. Fifth Metacarpal Fracture
Common Term – Boxer’s Fracture
Mechanisms
Indirect trauma, such as a striking blow with the fist
Symptoms
Sudden pain; loss of function; direct or indirect tenderness; poor ability to grip
Signs
Loss of function; inability to grip; possible deformity; rapid swelling; direct & indirect tenderness; possible bony deviation, crepitus, & false motion; delayed ecchymosis
Special Tests – Axial Load Test
Referral and Diagnostic Procedures
Orthopedist; X-Ray

36. Mallet Finger Common Term – Hammer Finger Mechanisms Symptoms Signs
Longitudinal force to the fingertip; forced flexion of the distal phalanx
Symptoms
Pain; loss of function; inability to extend distal phalanx
Signs
Deformity; fingertip is dropped down; possible crepitus; inability to extend distal phalanx; finger carried at 30 degrees
Special Tests
Range of motion of distal phalanx (extension)
Referral and Diagnostic Procedures
Orthopedist; X-Ray for possible avulsion fracture

37. Boutonnière Deformity
Common Term – Buttonhole Deformity
Mechanisms
Trauma to middle phalanx; forced flexion of the proximal interphalangeal joint; rupture of extensor tendon of the middle phalanx
Symptoms
Pain at point of injury; loss of function
Signs
Point tenderness over the dorsal middle phalanx; swelling; flexion deformity of proximal interphalangeal joint; instability to extend the finger; hyperextension of distal joint
Special Tests – PIP Range of Motion
Referral and Diagnostic Procedures
Orthopedist; X-Ray for possible fracture

38. Phalange Luxation Common Term – Dislocated Finger Mechanisms Symptoms
Direct trauma to joint of a phalanx; indirect force applied to the distal tip of the finger
Symptoms
Pain; loss of function
Signs
Marked deformity; loss of function; swelling; point tenderness
Referral and Diagnostic Procedures
Orthopedist; X-Ray for possible fracture

39. Flexor Digitorum Profundus Tendon Rupture
Common Term- Jersey Finger
Mechanisms
Forced extension of flexed distal phalanx
Symptoms
Pain; loss of function
Signs
Swelling; loss of function; pain distal to interphalangeal joints on volar surface; palpable mass on palm of injured hand; lacks full flexion of IP joints when joint is held in extension
Special Test
Flexor Digitorum Profundus Test
Referral and Diagnostic Procedure
Orthopedist

40. Thank You!