The Wrist, Hand, & Fingers – Common Injuries
Fractures
Distal forearm fractures of the radius & ulna
Colles’ Fracture
 Distal radius
 True Colle’s Fx
o
displacement of radius
o 1.5” proximal to radiocarpal joint
 Typically from
Smith’s Fracture
 “Reverse Colle’s Fracture”
 Distal radius

displacement of radius
 Typically from
Styloid process fracture
 Typical
fracture
 UCL or RCL stronger than styloid process
 HyperEpiphyseal fracture
 Fracture through the distal growth plate
Carpal fractures
Scaphoid fracture
o Most common carpal fracture (~70%)
 Especially in 15-30 year olds
o Pain in
&
Scaphoid Tubercle
o FOOSH
o Avascular necrosis
o Leads to non-union or malunion healing
 No universal treatment
 Displaced may require surgery
Hamate fracture
 May fracture body or hook
 Body = Direct blow or axial load to 4th & 5th
metacarpals
 Hook = FOOSH or swinging bat/golf club
 Movement
causes pain
when hook is fractured
Metacarpal fractures
 Compressive forces
o Axial or direct trauma
o Can have avulsions
 Sx & Sy:
o “Snap,” crepitus, etc.
o
o May not be able to make fist
Notes



Tx depends on rotation
“
fracture”
Bennett’s fracture
o
o Intra-articular (C-M joint)
o Typically needs fixation
Phalanx fractures
 Most common fractures of hand
 Thumb and middle finger are most common
sites
 Distal phalanx is most common
o Often involves avulsion of
tendon
 Direct blow = transverse or comminuted fx
 Rotational force =
fracture
 Patient will often hear “snap”
Dislocations/subluxations
 Wrist dislocations – very rare
 Carpal dislocations – Lunate
 MCP joint – most common in 1st MCP
 PIP & DIP joints – most common
Lunate dislocations
 MOI: forced
of wrist
 May move palmar or dorsally
 May reduce spontaneously
 Mechanism may also cause scaphoid fracture &
carpal instability
 Sx & Sy:
o
may become
level with other knuckles
o Pain at wrist & along radius
o May suffer from parasthesia in middle
finger
 Often, patient presents with no significant
findings except pain
o Will often have pain with
o X-ray or MRI needed to confirm
o Usually require surgery
o
MCP joint dislocation
 More common in thumb than fingers
o Often caused by extension and
abduction
 Often occurs w/fracture
The Wrist, Hand, & Fingers – Common Injuries
PIP & DIP joint dislocations
 Most common dislocation
 May remain displaced or spontaneously reduce
 Often reduced on-site by player, coach, etc.
 Often involve fractures
 Should
Sprains vs. strains
 Hard to distinguish the difference in the wrist
o
will indicate
 Typically due to hyperflexion or hyperextension
 Strain is to the tendon crossing at the wrist
 Sprain is Dx by r/o all other injuries
TFCC injury
 Often results from trauma or repeated stress
 “
” activities (gymnastics)
can cause degenerative injuries
 Sx & Sy:
o Forced
often
causes pain
o Pain with WB activities – push ups
o May have pain at ulnar styloid process
 Refer if suspected – often requires surgery
Sprains
IP joint sprains
 Very common w/ variety of mechanisms
 Typically involve
ligaments
 May result in dislocation
 May wait to report injury
MP joint sprains (thumb)
 Most often ulnar (medial) collateral ligament
 MOI: hyperabduction/extension
 “
thumb” or “skier’s
thumb”
 Loss of grip strength in opposition
Observable deformities
 Boutonniere deformity
 Swan-neck deformity
 Mallet finger
 Claw fingers
 Drop wrist
 Nail deformities
 Ganglion cysts
 Russell’s sign
Notes
de Quervain’s Syndrome
 Tenosynovitis =
 Structures Involved:
o Extensor Pollicis
o
Pollicis Longus
 Repeated RD and gripping
 Wrist movement & pinching increases symptoms
 Special test? =
Carpal tunnel syndrome
 Compression of the
nerve
o Symptoms often occur at night &
relieved by shaking
o Neurological symptoms, loss of grip
strength, “ache”
 Etiology: repetitive microtrauma of flexor
tendons
o Most patients 40-60 years old; more
common in females
o Often results from tenosynovitis or
trauma
Volkmann’s ischemic contracture
 Begins with fracture in humerus, where






Tight casting causes muscle spasm, swelling, or
bone pressure on
artery,
inhibiting circulation to forearm
Can become permanent
May be loss of motor & sensory function
Results from insufficient bloodflow & return to
forearm and hand
Sx & Sy:
o Pain in forearm - ↑ w/
of fingers
o Pain is followed by loss of brachial and
radial pulses, coldness in arm
o ↓ motion
Management
o Remove elastic wraps or casts
o Close monitoring must occur