Hand And Wrist Test (Sports Med)

Bennett’s fracture MOI

occurs at carpometacarpal joint of thumb as a result of an axial and abduction force to the thumb

Bennett’s fracture signs and symptoms

cmc may appear to be deformed, x-ray will indicate fracture, athlete will complain of pain and swelling over base of thumb

bennett’s fracture treatment

structurally unstable and must be referred to an orthopedic surgeon, surgery and immobilization are season ending

Biker’s palsey MOI

repetitive jarring or pressure, repetitive flexion, extension, ulnar deviation

biker’s palsey is….

ulnar nerve compression

biker’s palsey treatment

padding (gloves), ice, nsaids

Boutonniere deformity moi

rupture of extensor tendon dorsal to middle phalanx - bone passes through central slip. Forces dip joint into extension and pip into flexion

Boutonniere deformity signs and symptoms

severe pain, obvious deformity and inability to extend dip joint, swelling, point tenderness

Boutonniere deformity treatment

cold application, followed by splinting in pip extension and dip flexion, splinting must be continued for 5 to 8 weeks

boxer’s fracture is a…

fracture to the 5th metacarpal

boxer’s fracture moi

direct axial force or compressive force

boxer’s fracture signs and symptoms

pain and swelling, possible angular or rotational deformity

boxer’s fracture treatment

rice, analgesics are given followed by x ray examinations, deformity is reduced, followed by splinting - 4 weeks of splinting after which therapy starts

carpal tunnel syndrome moi

insidious onset with repetitive wrist and finger movement, acute onset with trauma, progressive degeneration

carpal tunnel syndrome signs and symptoms

numbness palmar thumb, index, middle fingers, dull ache, weak finger flexion, may worsen with sleep

carpal tunnel syndrome treatment

conservative (price and nsaids) and surgical

carpal tunnel special tests

tinel’s sign and phalen’s

deQuervains disease is….

stenosing tenosynovitis of the extensor pollicis brevis and abductor pollicis longus

deQuervains disease signs and symptoms

crepitation, tenderness, strength loss

deQuervains disease treatment

rice, nsaids

deQuervains disease special tests

finklesteins test

distal phalanx fracture moi

crushing force

distal phalanx fracture signs and symptoms

complaint of pain and swelling of distal phalanx, subungal hematoma is often seen in this condition

distal phalanx fracture treatment

rice and analgesics are given, protective splint is applied as a means for pain relief, subungal hematoma is grained

dupuytren’s contracture moi

nodules develop in palmar aponeurosis, limiting finger extension ultimately causing flexion deformity

dupuytren’s contracture signs and symptoms

often develops in 4th and 5th finger, flexion deformity

dupuytren’s contracture treatment

tissue nodules must be removed as they can ultimately interfere with normal hand function

gamekeeper’s thumb is also known as

skiers thumb

gamekeepers thumb moi

sprain of ucl of mcp joint of the thumb, mechanism is forceful abduction of proximal phalanx occasionally combined with hyperextension

gamekeepers thumb signs and symptoms

pain over ucl in addition to weak and painful pinch

gamekeepers thumb treatment

immediate follow up must occur, thumb splint should be applied for protection for 3 weeks or until pain free, splint should extends from wrist to end of thumb in neutral position, surgery may be required

jersey finger moi

rupture of flexor digitorum profundus tendon from insertion on distal phalanx, often occurs with ring finger when athlete tries to grab a jersey

jersey finger signs and symptoms

dip can not be flexed, finger remains extended, pip and point tenderness over distal phalanx

jersey finger treatment

must be surgically repaired, rehab requires 12 weeks and there is often poor gliding of tendon, with possibility of rerupture

lunate dislocation moi

force hyperextension, Palomar displacement (total rupture)

lunate dislocation signs and symptoms

deformity, 3rd knuckle is lower (murphy’s sign), parasthesia of middle finger, weak finger flexion

Mallet Finger moi

blow that contacts tip of finger avulsion extensor tendon from insertion, avulses extensor digitorum at distal phalanx

Mallet Finger signs and symptoms

unable to extend distal end of singer (carrying at 30 degree angle), point tenderness at sight of injury, x ray shows avulsed bone on dorsal proximal/distal phalanx

Mallet Finger treatment

rice and splinting in hyperextension for 6 to 8 weeks

paronychia is…..

infection around finger nail beds

paronychia signs and symptoms

redness, pain, drainage

paronychia treatment

warm soaks (betadine), antibiotic, referral

PIP dorsal dislocation MOI

hyperextension that disrupts volar plate at middle phalanx

PIP dorsal dislocation signs and symptoms

pain and swelling over pip, obvious deformity, disability and possible avulsion

PIP dorsal dislocation treatment

treated with rice, splinting and analgesics followed by reduction, after reduction finger is splinted at 20 to 30 degrees of flexion for 3 weeks, followed by buddy taping

what is the most common carpal injury

scaphoid fracture

scaphoid fracture moi

fall on outstretched hand

scaphoid fracture signs and symptoms

wrist aches, pain in anatomical snuff box, painful handshake or with overpressure

scaphoid fracture treatment

splint, referral, ice, immobilization (long and or short) - 12 weeks, plain x rays may not be enough

scaphoid fracture risks

aseptic recrosis and non union fractures

subungal hematoma moi

finger caught between two surfaces

subungal hematoma signs and symptoms

presents with bleeding under nail bed

subungal hematoma treatment

drainage, drill or cauterize

swan neck deformity moi

distal tear of volar plate or finger trauma, flexed mcp, extended pip, flexed dip

swan neck deformity signs and symptoms

pain, swelling with varying degrees of hyperextension, tenderness over volar plate of pip, indication of volar plate tear equals passive hyperextension

swan neck deformity treatment

rice and analgesics, splint in pip 20 to 30 degrees of flexion/dip extension for 3 weeks followed by buddy taping

triangular fibrocartilage injuries MOI

forced hyperextension of wrist with loading

triangular fibrocartilage injuries signs and symptoms

pain with pronation/extension and or ulnar deviation, pain with loading, point tenderness, swelling, altered joint mechanics

triangular fibrocartilage injuries treatment

immobilization and surgery are often necessary

triangular fibrocartilage injuries special tests

valgus test elicits pain but no laxity and varus test compresses and causes pain

trigger finger MOI

repeated motion of fingers may cause irritation, producing tenosynovitis. inflammation of tendon sheath (flexor tendon or wrist, finger, thumb)

trigger finger signs and symptoms

resistance to reextension, produces snapping that is palpable, audible and painful, palpation produces pain and lump can be felt in tendon sheath

trigger finger treatment

immobilization, rest, cryotherapy, nsaids, injection

Wrist ganglion is…

herniation of the joints capsule or synovial sheath of a tendon

wrist ganglion treatment

bible therapy

What is the anatomical snuff box and what is located there?

a triangular depression on the radial side of the wrist, contains radial artery, cephalic vein, and superficial branch of the radial nerve

bones of the hand

14 phalanges (2 sesmoid - thumb), 2 metacarpals, 8 carpal bones, distal radius and ulna,

bones of the wrist

8 carpal bones plus radius and ulna

How many bones are in each hand? And wrist?

27 bones in each hand and 8 bones in each wrist

What are the nerve innervations for the hand

median, ulnar, and radial nerves

psoriasis causes

scaling or ridging

hyperthyroidism causes

ridging and poor development

congenital/heart disease or chronic respiratory disease causes

clubbing and cyanosis

chronic alcoholism or vitamin deficiency causes

spooning or depression

what is murphy’s sign

when the 3rd knuckle is lower than the others, could indicate a lunate dislocation

median nerve innervates…

ring finger to thumb on the palmar side

radial nerve innervates…

parts of the ring finger to thumb on the dorsal side

ulnar nerve innervates….

pinky to the ring finger on the palmar side

how many carpometacarpal joint are there

5

bone interaction for the CMC 1 joint

trapezium

bone interaction for the CMC 2 joint

trapezoid

bone interaction for the CMC 3 joint

capitate

bone interaction for the CMC 4 joint

hamate & capitate

bone interaction for the CMC 5 joint

hamate

distal row of carpals

trapezium, trapezoid, capitate, hamate

proximal row of carpals

scaphoid, lunate, triquetrum, pisiform

FOOSH stand for

fall on outstretched hand

what 2 sets of motions occur at the metacarpophalangeal joints

flexion/extension and abduction/adduction

what 2 sets of motion occur at the radiocarpal joints

flexion/extension and radial/ulnar deviation

what bone is found in the anatomical snuff box?

scaphoid bone

what cmc joints have 2 sets of motion

1st and 5th cmc

what are the 2 sets of motion in the special cmc

flexion/extension and abduction/adduction

what set of motion occurs at distal radioulnar joint?

supination and pronation (80-90 degrees)

what type of joint is the thumb

saddle joint

what type of joint is the wrist

ellipsoid joint (aka condyloid)