1. Metacarpals Palpated in order Numbered 1 -5 Starting at thumb Palpate the entire length 1st Metacarpal From Snuffbox to MCP JointFrom Snuffbox to MCP Joint Shorter and broader than other metacarpalsShorter and broader than other metacarpals Trapezium 1st Metacarpal

2. –Etiology Direct axial force or Compressive force 5th metatarsal –Boxing or martial arts –(boxer’s fracture) –Signs and Symptoms Pain Swelling Crepitus Possible deformity –angular –rotational Metacarpal Fracture –Fracture tests PalpationPalpation CompressionCompression Axial compressionAxial compression PercussionPercussion –Management RICERICE AnalgesicsAnalgesics X-ray examinationX-ray examination Deformity is reducedDeformity is reduced SplintingSplinting –30 degrees of flexion –4 weeks

3. Etiology –Direct trauma –Twist Signs and Symptoms –Pain –Swelling –Deformity –Crepitus Phalangeal Fractures ManagementManagement –RICE –Proximal Fracture SplintSplint Buddy tapingBuddy taping –Middle Fracture No deformityNo deformity –Buddy tape w/ thermoplastic splint for activity DeformityDeformity –Immobilization for 3-4 weeks –Protective splint for an additional 9-10 weeks during activity Proximal Fracture Middle Fracture

4. Distal Phalangeal Fracture Etiology –Crushing force Signs and Symptoms –Pain –Swelling –Crepitus –Subungual hematoma ManagementManagement –RICE –Protective splint 0º flexion0º flexion

5. Joints Metacarpophalangeal Joint Proximal Interphalangeal Joint –(PIP Jt.) Distal Interphalangeal Joint –(DIP Jt.) Interphalangeal Joint –Thumb (IP)

6. IP Joint Anatomy Volar Plate Collateral Ligament Volar Plate Collateral Ligament Accessory Ligament Checkrein Ligament Accessory Ligament Middle Phalange Proximal Phalange Proximal Distal Middle Phalange

7. Etiology –Fingers are prone to sprains –Direct blows or twisting –Occurs w/ axial loading or –Valgus/varus stresses –Similar to fractures and dislocations –Injury can damage Collateral ligaments Volar plate IP Joint Sprains Special TestsSpecial Tests –Fracture tests –Radial and Ulnar deviation Assess collateral ligamentsAssess collateral ligaments –Anterior and posterior glide tests Assess joint capsuleAssess joint capsule

8. Interphalangeal Joint Sprains Volar Plate Collateral Ligament Management –RICE –X-ray examination –PIP sprain 30 - 40º flexion 10 days –DIP Sprain Splint for a few days Full extension Taping

9. Metacarpophalangeal Joints Head of 2nd Metarsal (MC-P Joints) Assessment –Place joint in full flexion –Radial deviation –Ulnar deviation –Rotation PalpationPalpation –Place joint in flexion –Joint exposed better –Groove for extensor tendon

10. –Etiology Hyperextension Dorsal PIP Axial load on a partially flexed DIP joint PIP and DIP Dislocations –Signs and Symptoms Obvious deformityObvious deformity SwellingSwelling Possible avulsion volar platePossible avulsion volar plate Possible fracturePossible fracture –Management RICERICE Reduction by MDReduction by MD Post reduction splintingPost reduction splinting Buddy tapingBuddy taping Begin motion at 3 weeksBegin motion at 3 weeks Large bone fragments splint 30-60º flexionLarge bone fragments splint 30-60º flexion Small bone fragments buddy tapingSmall bone fragments buddy taping

11. –Etiology Caused by a blow that contacts tip of finger Mallet Finger (baseball or basketball finger) –Etiology DIP joint injuryDIP joint injury Rupture of flexor muscleRupture of flexor muscle Common injury to football linemanCommon injury to football lineman Jersey Finger

12. Subungual Hematoma Bruising bleeding under fingernailBruising bleeding under fingernail Extremely painful due to build-up of pressure under nailExtremely painful due to build-up of pressure under nail –Pressure must be released once hemorrhaging has ceased –Release as distally as possible –Bandage with antibiotic ointment –Hot paper clip –Finger nail drill –Scalpel