traumatic wrist/hand diagnoses

what joints do you screen with a thumb injury?

fingers, wrist

what joints do you screen with a hand injury?

wrist screen

what joints do you screen with a wrist injury?

elbow, hand

is A/PROM contraindicated or not contraindicated with soft tissue injury?

not contraindicated

is A/PROM contraindicated or not contraindicated with a fracture?

contraindicated

what should you ask about when taking the subjective?

recent falls, involved in a MVA, any head/neck pain after the injury, position of the wrist/hand during the injury, hearing a "click" or "pop" at the injury, immediate or delayed swelling, ability to move wrist/hand after the injury and at the time of the eval, focal area of tenderness

when does brusing typically occur on the dorsal part of the hand?

with carpal injuries

what movement in the elbow can indicate an injury in the hand?

extension

acute wrist trauma combined with what requires a referral?

localized tenderness, pain on active motion, pain on passive motion, pain on grip, pain on supination

what is the most common fracture of the distal radius?

colles fracture

how does a colles fracture present?

radial fracuture with dorsal displacement, FOOSH with the wrist in extension, "dinner fork", difficulty with gripping, TTP at distal radius

how does a smith's fracture present?

distal portion displaced volarly, FOOSH with wrist in flexion

what is the most common carpal fracture?

scaphoid

how does a scaphoid fracture present?

FOOSH with impact on thenar eminence, pain/tenderness/swelling on radial side of wrist, AROM limitation of wrist and thumb

symptoms of scaphoid fracture

deep dull ache in radial wrist, painful wrist movements, pain with griping, mild swelling, bruising on dorsal wrist, limited and painful A/PROM of wrist

what can a scaphoid fracture lead to?

avascular necrosis

what are the special tests for a scaphoid fracture?

snuffbox tenderness, scaphoid compression test

how do you perform the scaphoid compressio test?

holds patients thumb and applies long-axis compression through metacarpal bone into scaphoid

what are the best tests to rule IN a scaphoid fracture?

scaphoid palpation, resisted supination

whare are the best tests to rule OUT a scaphoid fracture?

scaphoid palpation, longitudinal compression, resisted supination

how does Keinbock's disease present?

avascular necrosis of lunate, FOOSH, men 18-40 y.o., dorsal wrist pain radiating into the forearm, symptoms may have started months or years before diagnosis

what is common when a traumatic TFCC injury occurs?

catching/clicking in the movement followed by pain

what are the special tests for a traumatic TFCC injury?

supination with end range overpressure, press test

how does a volar plate injury present?

dislocation or jamming, forced hyperextension or axial load through finger, tears volar plate, pain with passive hyperextension, tender over volar IP, avulsion fracture, potential for instability or dislocation

how can you test for a volar plate injury?

pain, swelling, limited AROM, loss of pinch power, potential deformity if dislocated

how do you splint a volar plate injury?

in flexion

how does mallet finger present?

forced flexion of extended DIP, disruption of the terminal extensor mechanisms, potential avulsion fracture

how do you check for mallet finger?

stabilize the middle phalanx and ask them to extend their DIP

how do you splint a mallet finger?

in hyperextension of the DIP to allow for scarring

how does a jersey finger present?

common in rock climbing/sports, avulsion of the FDP in any finger, hyperextension stress applied to a flexed finger, unable to flex DIP

what is the common treatment for jersey finger?

surgery then splinting

what is the special test for jersey finger?

MMT of the flexor digitorum profundus

what is the most common soft tissue injury in the thumb?

UCL injury/tear

how does a thumb UCL tear present?

"skier's thumb", aggravated by extension or abduction, pain on the ulnar aspect of the thumb, weakness with adduction or flexion of the MCP

what are the special tests for a thumb UCL injury?

pain with hyperextension and hyper abduction of the thumb, UCL terss test

how do you perform the UCL stress test?

wuth the thumb in extension apply a valgus stress to the MCP joint of the thumb

how does a boxer's fracture present?

axial loading to the 4th and 5th metacarpal due to stricking an object with a closed fist, more common with men

how does a Bennett's fracture present?

fracture of the base of the 1st metacarpal extending into the CMC joint, from axial force against a partially flexed metacarpal, young males, boxing/martial arts

treatment for fractures

immobilized until fully healed

treatment for nerve compressions

decompressed through surgery, splinting, or altering activities that lead to compressive positions

treatment for fibrocartilage, ligamentous, and tendon tears

splinted/immobilized to allow healing, likely will need surgical reconstruction