1. Wrist/Hand
Sports med 2

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)

3. 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

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

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

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

7. 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

8. 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

9. 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

10. 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

11. 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

12. Finkelsteins Test tests for de Quervain’s disease
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

13. Phalens Test Procedure Positive Test
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

14. 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

15. 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

16. Glide Test Procedure Positive Test
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

17. 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

18. 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

19. 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

20. 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

21. 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

22. 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

23. 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

24. Allens Test Procedure Positive Test
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

25. 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

26. 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

27. 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

28. 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