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Wrist and Hand Injuries

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					Wrist and Hand
   Injuries



     Sports Medicine II
       Chapter Objectives
 AKA – What I Want You To Learn


• Understand the basic anatomy of the wrist and
  hand
• Explain various types of injuries that occur
• Understand common mechanisms that cause
  injuries of the wrist and hand
• Understand the signs and symptoms of the
  various types of fractures of the wrist and hand
  Organizational Chart of the
   Wrist & Hand Anatomy

        Hand & Wrist Anatomy

Bones      Joints   Muscles Ligaments
   Bony Anatomy of the Wrist and
              Hand

         Wrist and Hand Anatomy
                                    Joints        Muscles        Ligaments
                  Bones

Radius    Ulna     Carpals       Metacarpals     Phalanges


                 7 Carpal Bones    Hand            Fingers
                     Wrist      5 metacarpals   14 total bones
Bony Anatomy of the Wrist
                    Carpal Bones
                                   = (Navicular)
• Pneumonic for carpal
  bones of the wrist
  –   Some (Scaphoid)
  –   Late (Lunate)
  –   Trainers (Triquetral)
  –   Practically (Pisiform)
  –   Taped (Trapezium)
  –   Tommy’s (Trapezoid)
  –   Clean (Capitate)
  –   Hand (Hamate)
         Metacarpals & Phalanges
• There are five metacarpal
  bones (numbered I – V,
  starting with the thumb)     I                   V
• There are 14 phalange            II         IV
                                        III
  bones
• The thumb is the only
  finger with two phalanges
• Which Metacarpal do you
  think is broke most often?
  Why?
              Joints of the Wrist and Hand

                                           Wrist and Hand Anatomy
                   Bones                         Joints                          Muscles                           Ligaments


        Wrist - Hand                   Hand - Finger                                   Finger Joints


   Carpometacarpal Joint         Metacarpal Phalangeal Joint Proximal Interphalangeal Joint       Distal Interphalangeal Joint
Where the arm meets the hand                MCP                        PIP Joint                               DIP
                               Joint between the hand & fingers
               Wrist & Hand Joints
• The Carpometacarpal Joint
  is located where the arm
  meets the hand
• The Metacarpal
  phalangeal joint is located
  between the hand and the
  fingers
• The Interphalangeal Joints
  are between each phalange
  (basically, if you look at
  your fingers, everywhere
  you have a crease is a joint)
Muscles of the Wrist and Hand
                  Hand & Wrist Anatomy




Bones    Joints                     Muscles              Ligaments




                   Flexor Muscles         Extensor Muscles
            Wrist Muscle Anatomy
• The wrist and hand
  movements are controlled
  by many different muscles
• The flexor muscle groups
  are located on the anterior
  surface of the forearm
• The extensor muscle groups
  are located on the posterior
  aspect of the forearm
Ligaments of the Wrist & Hand

                 Hand & Wrist Anatomy
Bones   Joints             Muscles            Ligaments

                     Ulnar Collateral Lig Radial Collateral Lig Interphalangeal Lig
                  Wrist Ligaments
• Most injuries to the wrist and
  fingers are sprains.
• In many cases they are not
  serious and can be treated
  using the PRICE method.
• One common misconception
  about sprains of fingers is that
  they must be pulled back into
  place. This is not true!
• Pulling on an injured ligament
  can only cause more injury.
       Wrist & Finger Injuries

•   Wrist Sprains                    Ligament Injuries
•   Gamekeeper’s Thumb (Skier’s Thumb)
•   Interphalangeal Collateral Ligament Sprains
•   Dislocated Fingers
•   Tendonitis                Muscle & Tendon Injuries
•   Mallet Finger
•   Jersey Finger
•   Boutonniere Deformity
•   Colles’ Fx                           Bone Injuries
•   Scaphoid Fx
•   Boxer’s Fx)
     Preventing Wrist Injuries
• Protective equipment can be used to prevent
  injury some items include:
     •   Braces
     •   Tape
     •   Gloves
     •   Padding
• Be aware of the rules of the sport. Some
  sports prohibit the use of hard substances such
  as braces or only allow protective equipment
  with a doctors note
Hand & Wrist Ligament
      Injuries
                 Wrist Sprains
• Commonly occur from overuse, falls, and
  forceful twisting motion.
• Signs & Symptoms generally include:
     •   Pain
     •   Decreased ROM (possibly)
     •   Decreased grip strength
     •   Swelling
• Treatment generally involves:
     • PRICE
     • Reestablish ROM and Strength
     • Tape or brace on return to competition for support
             Gamekeeper’s Thumb
              aka: Skier’s Thumb
• An injury to the medial collateral
  ligament (ulnar collateral ligament)
  of the thumb.
• This term is an old one that was first
  used to describe the farmer who
  injured his medial collateral ligament
  when breaking the necks of birds
  intended for the cooking pot.
• In more recent times, it has become
  known as skier’s thumb do to the
  high incidence of medial collateral
  thumb injuries in skiing.
              Gamekeeper’s Thumb
                 Mechanism
• The thumb is injured
  when it is forcefully
  abducted (e.g., a
  basketball being caught)
• May also be injured in a
  fall or a direct hit to the tip
  of the thumb
Gamekeeper’s Thumb Treatment
• Treatment involves
  splinting the medial
  aspect of the thumb and
  icing.
• An X-ray is necessary to
  determine if an avulsion
  fracture is associated
  with the ligament
• If there is an avulsion,
  surgery is generally
  required to fix the injury
Gamekeeper’s Thumb Pics
       INTERPHALANGEAL COLLATERAL
             LIGAMENT SPRAIN
• A collateral ligament is located
  on the side of each
  interphalangeal joint.
• The ligaments provide stability
  when the phalanges are stressed.
• Examples of mechanism of
  injury include; tip of the finger
  hit by a ball, or if the athletes
  finger accidentally gets caught in
  an opposing players jersey
     INTERPHALANGEAL COLLATERAL
      LIGAMENT SPRAIN TREATMENT

• Injury to the collateral ligament is painful and
  disabling. The joint can swell and become
  discolored.
• Treatment involves:
     •   X-ray to rule out fracture
     •   Ice to minimize swelling
     •   Splint when not playing
     •   To play “buddy tape” to the next largest finger
     •   Pad if necessary
       FINGER DISLOCATIONS
• Dislocations of the phalanges occur
  frequently in sports and are mainly
  caused by blows to the tip of the
  finger
• When a dislocation of the IP or
  MCP joint occurs, one bone usually
  movers dorsal and one anterior.
• The team physician should relocate
  all dislocated fingers and thumbs
  because tiny tendons, nerves, and
  blood vessels course there way
  through the joint space
• If not reduced properly there can be
  permanent damage to that finger.
FINGER DISLOCATION PICS
    FINGER DISLOCATION
        TREATMENT
•   Splint the dislocation
•   Use ice to control swelling and pain
•   Refer to physician for reduction and x-ray
•   Most dislocations are splinted for about 3
    weeks in 30 degrees of flexion
Hand & Wrist Muscle and
    Tendon Injuries
                              Tendonitis
• Tendonitis is defined as
  inflammation of the tendon.
• Mechanism of injury:
      • Overuse
      • Stretching
      • Impact
• Signs & Symptoms
      • Generalized Swelling
      • Tenderness
      • Inability to flex the wrist
• Treatment
      • PRICE for 24-48 hours
      • Gradually begin heat
      • Begin hand-strengthening
                     Mallet Finger
• Mallet finger is the result of the fingertip receiving an
  impact.
• The impact causes the extensor tendon to be torn.
• The fingertip will be permanently in flexion. If you ask the
  athlete to straighten the fingertip, they will be unable to do
  so.
Mallet Finger Pics
        Mallet Finger Treatment
• Ice bag
• Splint in extension
• Refer to physician
• The doctor has two courses of action; treat it
  surgically or keep it splinted in extension.
• In many instances an athlete will not consider
  this injury very important and fail to report it.
• This will result in a permanent flexion of the
  DIP joint. (Ask to see a Coaches fingers, many
  have mallet fingers that were never fixed)
Mallet Finger Treatment Pics
                  Jersey Finger
• Jersey finger is very similar to mallet finger except
  that the flexor tendon tears from the fingertip usually
  pulling a piece of bone away with it.
• This injury usually occurs when the athlete is holding
  an opponent’s jersey with a fist, and his finger is
  forced to extend, which tears the tendon.
Jersey Finger Mechanism
         Jersey Finger Treatment

• Splint and ice
• Send for an x-ray and
  evaluation by doctor
• Physician will
  determine the need
  for surgery or further
  splinting
             Boutonniere Deformity
• A boutonniere deformity occurs at the proximal interphalangeal
  (PIP) joint of the fingers
• A hard hit to the PIP joint can cause the joint capsule to tear and
  the extensor tendons to fall laterally.
• When this happens the athlete will be able to flex the DIP joint,
  but will not be able to extend the PIP joint.
  Boutonniere Deformity Treatment
• The ATC will splint the
  finger and refer to the
  physician
• In many cases the finger
  can be splinted, allowing
  the connective tissue that
  keeps the extensor
  tendons in place to heal
• In some cases surgery is
  required.
Wrist & Hand Bone Injuries
                Colles’ Fractures
• A Colles’ fracture is a
  wrist fracture involving
  a break of the end of the
  radius bone.
• Named after
  Dr.Abraham Colles




                        ABRAHAM COLLES
                        (1773-1843)
           Colles’ Fx Mechanism

• Wrist fractures occur
  most often in a fall or in
  a motor vehicle accident,
  but any sufficiently
  strong force on the hand
  can break the wrist. The
  wrist can be broken from
  a sudden force pushing
  the hand backwards.
  Colles’ Fx Mechanism Continued

• A strong force pushing
  the hand into the forearm
  can also cause a Colles
  fracture, which often
  involves a break of the
  radius bone near its end.
  There is a natural weak
  spot in the radius where
  it widens.
Colles’Fx Pictures
            Colles’ Fx Treatment
•   Ice
•   Splint
•   Sling
•   Treat for shock
•   EMS if needed for transport to the doctor
•   Generally the doctor or ER will x-ray and cast.
•   However if the break is bad and will not align
    correctly, surgery (pins, screws, or wires) may
    be required.
Colles’ Fx Treatments Pics
                Scaphoid Fracture
• The scaphoid bone is the most frequently fractured carpal bone.
• Generally the injury is caused by a force on the outstretched
  hand, which compress the scaphoid (navicular) between the
  radius and the second row of carpal bones.
• This injury is often mistaken for a wrist sprain, and as a result
  the required immobilization is not carried out.
• This can be a problem because of the inadequate blood supply
  to the scaphoid. Avascular necrosis (bone death due to lack of
  blood flow) will occur.
• Even after proper splinting the navicular fractures may not heal
  and may have to be surgically repaired.
Scaphoid Fx Mechanism &
  Anatomical Snuffbox


             Anatomical Snuffbox




              Bonus: Find out why this
              is called the snuffbox!
    Scaphoid Fracture Treatment
• Signs & Symptoms will include:
     • Swelling in the area of the carpal bones
     • Severe point tenderness in the anatomical snuffbox
     • Pain elicited by upward pressure exerted on the long axis
       of the thumb and radial flexion
• Treatment
     •   Ice
     •   Splint
     •   Referral for an x-ray
     •   Casting usually last for 8 weeks
     •   Strengthening and taping after cast removal
               Metacarpal Fractures
• Metacarpal fractures are common in contact sports.
• Mechanism usually involves:
       • Striking an object
       • Having the hand stepped on
• Signs & symptoms include:
       • Pain
       • Deformity
       • Swelling
       • Abnormal mobility
• In particular, a lot of athletes will become upset about many non-
  sport related (or sport related) issues and punch something (wall,
  locker, equipment, person, etc.) causing a fracture of the 5th
  metacarpal. This is known as a “Boxer’s Fracture”
Boxer’s Fracture Pics
    Metacarpal Fracture Treatment
•   Splint using a roll of gauze in the palm of the hand
•   Ice
•   Referral to a physician for x-ray and treatment
•   In most cases the metacarpal can be placed in a cast,
    but in severe cases surgery is required.
Boxer Fracture Treatment Pics
The End

				
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