Transcript Hand, Wrist & Fingers

Metacarpals
• Palpated in order
• Numbered 1 -5
• Starting at thumb
• Palpate the entire length
Trapezium
1st Metacarpal
1st Metacarpal
• From Snuffbox to MCP Joint
• Shorter and broader than other metacarpals
Metacarpal Fracture
– Etiology
• Direct axial force or
• Compressive force
• 5th metatarsal
– Boxing or martial arts
– (boxer’s fracture)
– Signs and Symptoms
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•
•
•
Pain
Swelling
Crepitus
Possible deformity
– angular
– rotational
– Fracture tests
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•
•
•
Palpation
Compression
Axial compression
Percussion
– Management
•
•
•
•
•
RICE
Analgesics
X-ray examination
Deformity is reduced
Splinting
– 30 degrees of flexion
– 4 weeks
Phalangeal Fractures
Proximal Fracture
• Etiology
– Direct trauma
– Twist
• Signs and
Symptoms
Middle Fracture
• Management
– RICE
– Proximal Fracture
• Splint
• Buddy taping
– Middle Fracture
– Pain
• No deformity
– Swelling
• Deformity
– Deformity
– Crepitus
– Buddy tape w/ thermoplastic splint for activity
– Immobilization for 3-4 weeks
– Protective splint for an additional 9-10 weeks during
activity
Distal Phalangeal Fracture
• Etiology
– Crushing force
• Signs and Symptoms
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–
–
–
Pain
Swelling
Crepitus
Subungual hematoma
• Management
– RICE
– Protective splint
• 0º flexion
Joints
• Metacarpophalangeal Joint
• Proximal Interphalangeal Joint
– (PIP Jt.)
• Distal Interphalangeal Joint
– (DIP Jt.)
• Interphalangeal Joint
– Thumb (IP)
IP Joint Anatomy
Middle
Phalange
Collateral Ligament
Accessory Ligament
Volar Plate
Checkrein Ligament
Collateral Ligament
Accessory Ligament
Distal
Middle Phalange
Proximal
Phalange
Proximal
Volar Plate
IP Joint Sprains
•
Etiology
•
Special Tests
– Fingers are prone to sprains
– Fracture tests
– Direct blows or twisting
– Radial and Ulnar deviation
– Occurs w/ axial loading or
– Valgus/varus stresses
– Similar to fractures and dislocations
– Injury can damage
• Collateral ligaments
• Volar plate
• Assess collateral ligaments
– Anterior and posterior glide tests
• Assess joint capsule
Interphalangeal Joint Sprains
• Management
– RICE
– X-ray examination
– PIP sprain
• 30 - 40º flexion
• 10 days
– DIP Sprain
• Splint for a few days
• Full extension
• Taping
Collateral Ligament
Volar Plate
Metacarpophalangeal Joints
(MC-P Joints)
Head of 2nd
Metarsal
• Palpation
• Assessment
– Place joint in flexion
– Place joint in full flexion
– Joint exposed better
– Radial deviation
– Groove for extensor tendon
– Ulnar deviation
– Rotation
PIP and DIP Dislocations
– Etiology
• Hyperextension Dorsal PIP
• Axial load on a partially flexed DIP joint
– Management
• RICE
• Reduction by MD
• Post reduction splinting
– Signs and Symptoms
•
•
•
•
Obvious deformity
Swelling
Possible avulsion volar plate
Possible fracture
• Buddy taping
• Begin motion at 3 weeks
• Large bone fragments splint 30-60º
flexion
• Small bone fragments buddy taping
Mallet Finger (baseball or basketball finger)
– Etiology
• Caused by a blow that contacts tip of finger
Jersey Finger
– Etiology
• DIP joint injury
• Rupture of flexor muscle
• Common injury to football lineman
Subungual Hematoma
•Bruising bleeding under fingernail
•Extremely painful due to build-up of pressure under nail
–Pressure must be released once hemorrhaging has ceased
–Release as distally as possible
–Bandage with antibiotic ointment
–Hot paper clip
–Finger nail drill
–Scalpel