Wrist and Finger Injuries

Range of Motion of Wrist and Fingers

• Carpometacarpal Joint
  • Flexion: 70-80 degrees
  • Extension: 70-80 degrees
  • Abduction: 70-80 degrees
  • Adduction: 70-80 degrees
  • Opposition
• Metacarpophalangeal Joint
  • Flexion: 85-105 degrees
  • Extension: 20-35 degrees
  • Abduction/Adduction: 20-25 degrees
• Interphalangeal Joints
  • Thumb Flexion: 80-90 degrees
  • PIP Flexion: 110-120 degrees
  • DIP Flexion: 80-90 degrees

Common Hand Pathologies

Tendon Pathologies

• Trigger Finger/Thumb

  • Etiology: Repeated motion causing tendon sheath irritation.
  • Signs/Symptoms: Resistance on re-extension, snapping, palpable lump, pain on palpation.
  • Management: Immobilization, rest, cryotherapy, NSAIDs, possible injection.

• Mallet Finger

  • Etiology: Blow to fingertip causing extensor tendon avulsion.
  • Signs/Symptoms: Inability to extend distal end of finger (carrying at 30-degree angle), tenderness, X-ray shows avulsed bone.
  • Management: RICE and splinting in hyperextension for 6-8 weeks.

• Boutonniere Deformity

  • Etiology: Rupture of extensor tendon, causes PIP flexion and DIP extension.
  • Signs/Symptoms: Severe pain, deformity, inability to extend DIP joint.
  • Management: Cold application, splinting in PIP extension and DIP flexion for 5-8 weeks.

• Jersey Finger

  • Etiology: Rupture of flexor digitorum profundus tendon.
  • Signs/Symptoms: PIP cannot be flexed, pain over distal phalanx.
  • Management: Surgical repair required, rehab takes 12 weeks.

• Dupuytren's Contracture

  • Etiology: Nodules developing in palmar aponeurosis.
  • Signs/Symptoms: Flexion deformity often in 4th or 5th finger.
  • Management: Removal of nodules.

• Swan Neck Deformity

  • Etiology: Distal tear of volar plate, causes flexed MCP and extended PIP.
  • Signs/Symptoms: Pain, swelling, tenderness.
  • Management: RICE, splinting for 3 weeks in specific positions.

Sprains and Fractures

• Sprains

  • Etiology: Direct blow or twisting injury to phalanges.
  • Signs/Symptoms: Pain, swelling, hemorrhaging.
  • Management: RICE, splinting for 10 days, possible physical therapy.

• Gamekeeper's Thumb

  • Etiology: Sprain of UCL at MCP joint.
  • Signs/Symptoms: Pain and weakness in pinch grip.
  • Management: Thumb splint for 3 weeks, possible surgery.

• Fractures

  • Etiology: Direct trauma or severe twisting.
  • Signs/Symptoms: Pain, swelling, possible deformity.
  • Management: RICE, X-ray, splinting, and therapy as required.

Types of Fractures

• Distal Phalanx Fracture

  • Etiology: Crushing force.
  • Signs/Symptoms: Pain, swelling, subungual hematoma.
  • Management: RICE, analgesics, protection splint.

• Middle Phalangeal Fracture

  • Etiology: Direct trauma or twist.
  • Signs/Symptoms: Pain, possible deformity.
  • Management: RICE, buddy tape if no deformity, splint for 3-4 weeks with extended time if deformity present.

• Proximal Phalangeal Fracture

  • Etiology: May be spiral or angular.
  • Signs/Symptoms: Pain and swelling.
  • Management: RICE, splinting.

Wrist Injuries

• Wrist Ganglion

  • Description: Herniation of the joint capsule.
  • Treatment: Conservative, may involve Bible therapy.

• Sprains

  • Onset: Acute from FOOSH or overexertion.
  • Management: PRICE, rehabilitation.

• TFCC Injuries

  • MOI: Forced hyperextension with loading.
  • Management: Possible immobilization or surgical intervention.

• Wrist Fractures

  • Colles Fracture: Hyperextension with “silver fork deformity.”
  • Smith's Fracture: Hyperflexion with “garden spade deformity.”
  • Scaphoid Fracture: Most common, requires splinting and monitoring for avascular necrosis.

Neural Injuries

• Carpal Tunnel Syndrome

  • Etiology: Compression of the median nerve from repetitive movement.
  • Signs/Symptoms: Numbness in fingers, weak grip.
  • Management: Conservative treatment, possible surgery.

• Biker's Palsy

  • Etiology: Ulnar nerve compression from repetitive stress.
  • Management: Padding, ice, NSAIDs.