KIN 420 - Module 7 Slides-1

KIN 420: Prevention of Athletic InjuriesInstructor: Anne Lasinsky, PhDLocation: UBC

Table of Contents

• Hand and Finger Injuries

• Anatomy of the Hand and Volar Plate

• Common Hand Injuries

• Clinical Approach

• Treatment Principles

• Wrist Injuries

• Elbow Injuries

Hand and Finger Injuries

About 15% of injuries in sports affect the hand and fingers, underscoring the significance of recognizing and managing these injuries within sports medicine.

• Function of the Thumb: The thumb plays an essential role in hand functionality; it is crucial for grip strength and executing precise movements. Injuries to this region can substantially impair functionality, affecting both athletic performance and daily life.

• Rehabilitation Requirements: Numerous hand injuries demand thorough rehabilitation to regain full functionality. Prompt intervention is vital to avert long-term issues, enhance recovery outcomes, and reduce the chances of re-injury. Athletes should be informed about the limitations of self-healing, as many may believe that such injuries will mend themselves without appropriate care.

Anatomy of the Hand and Volar Plate

Finger Structure:

• Each finger is made up of three phalanges (proximal, middle, distal) with the thumb consisting of two (proximal and distal) accompanied by its metacarpal.

• Intrinsic and Extrinsic Muscles: Intrinsic muscles are vital for fine-tuned movements within the hand, while extrinsic muscles offer force and control from the forearm.

• Volar Plate: This fibrocartilaginous structure situated on the volar surface of the proximal interphalangeal joint (PIP) is critical in stabilizing the joint and preventing hyperextension, which is essential for gripping functions.

• Tendon Roles: Flexor tendons play a role in gripping by connecting to the phalanges, whereas extensor tendons are responsible for finger extension, which is necessary for various activities.

Common Hand Injuries

List of Common Injuries:

• Flexor Digitorum Profundus Avulsion (Jersey Finger): Often seen in tackling sports, this injury frequently necessitates surgical repair due to its effect on grip strength.

• Flexor Tendon Pulley Rupture (Climber’s Finger): Common among climbers, this injury may require taping or surgery to restore normal function.

• Boxer’s Knuckle (Sagittal Band Rupture): Typically observed in boxing, treatment usually involves splinting, or surgical reconstruction in severe cases.

• Skier's Thumb (Ulnar Collateral Ligament Rupture): This injury can vary from a mild sprain needing splinting to a severe complete rupture requiring surgical intervention, particularly if a Stener lesion is present.

Clinical Approach

Understanding Injury History and Mechanism:Determining the mechanism of injury (MOI) is vital for accurate diagnosis of hand and finger injuries. It aids clinicians in identifying signs that may denote fractures or other types of injuries.

• Physical Examination:

  • Evaluate the posture, guarding reactions, and any apparent deformities in the hand.

  • Assess range of motion (ROM) by quantifying flexion and extension at different joints to evaluate hand functionality.

  • Execute special tests to evaluate ligament and tendon stability, along with additional diagnostic assessments based on initial findings.

Treatment Principles

Effective management starts with proper early treatment of hand and finger injuries. Core objectives include:

• Reduction of Pain and Swelling: Employ suitable interventions to alleviate pain and minimize swelling at the injury site.

• Injury Protection: Implement strategies such as splinting and immobilization to safeguard the injured area from further harm during the early healing phase.

• Active Movement Therapy: Start rehabilitation methods aimed at restoring mobility and strength in the affected area.Control of Edema:Techniques recommended for controlling swelling include splinting, icing, elevating the injured part, and applying specific therapeutic exercises designed to diminish swelling and enhance blood circulation.

Exercise Protocols:Develop protocols that include blocking exercises focusing on injured tissues, gradually introducing strengthening exercises customized to each athlete’s recovery needs.

Wrist Injuries

Common Pathologies:Frequent wrist injuries encompass distal radius fractures, scaphoid fractures, and tendonitis, all of which necessitate timely and effective assessment.

• Evaluation:Emphasize MOI and personal history while performing a comprehensive physical examination for signs such as swelling, pulsativity, and functional assessment.

• Special Tests: Apply specific examinations to evaluate scapho-lunate stability, assess the triangular fibrocartilage complex (TFCC) integrity, and identify symptoms of carpal tunnel syndrome.

Elbow Injuries

Overview of Anatomy:Review both the medial and lateral aspects, focusing on various flexor and extensor muscle groups engaged in elbow motion.Examination Techniques:

• Conduct a detailed visual assessment of the elbow for signs of swelling and tenderness while analyzing range of motion through active and passive evaluations (AROM and PROM).

• Determine carrying angle and assess stability via palpation and specific stress testing methods.

Medial and Lateral Elbow Pain:Conditions like extensor tendinopathy (e.g., Tennis Elbow) and flexor-pronator tendinopathy can cause localized pain and functional issues.

• Management Strategies:Management plans may incorporate customized therapeutic exercises, adjustments in activity levels, and potentially surgical options aimed at restoring function and alleviating discomfort.

Ulnar Nerve Considerations:Ulnar nerve issues can arise from nearby soft tissue injuries or joint problems, leading to sensory and motor challenges. A detailed examination is required to identify any motor and sensory impairments related to this nerve, facilitating a plan for corrective or supportive interventions.