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