Injuries to Hand, Wrist and Forearm

- Mr. Brewer

Injuries to the Phalanges- Although your fingers may seem

insignificant and minor at times, some of the most debilitating injuries occur at, and around the phalanges.

- We often times take for granted how much we use our fingers in everyday life, thus the reason some of these injuries, although they appear minor, can have very major impacts on everyday routines.

Finger Fractures

• Finger fractures can occur at any of the 3 phalange bones of the 4 lateral fingers.

• An avulsion fracture can also can occur.– An avulsion fracture is when

a piece of bone is detached while still connected to the tendon or ligament.

– An Avulsion fracture can result in one of the common injuries that we will discuss.

Finger Conditions• Jersey Finger

– Rupture of the flexor digitorum profundus tendon.

– When you attempt to flex all of your fingers, due to the tendon being ruptured, the finger being affected will not flex with others.

– USUALLY the “ring finger”– Called “Jersey Finger” because commonly

happens when you grab someone else’s jersey.

• Trigger Finger– Tendonitis that forms from repetitive flexion

that rubs on the tendon sheath.– As tissue scars and nodules form, the finger

can become “stuck” in flexion.– Commonly noticed when re-extension of

finger is painful or difficult.

Finger Conditions

• Mallet Finger (AKA Baseball/Basketball finger):– Caused by a blow to

the tip of the finger, jamming and avulsing the extensor tendon from it’s insertion.

– Patient will be UNABLE to extend the distal phalanx.

Finger Conditions

• Swan Neck Deformity:– Usually a distal tear of

the volar plate from the middle phalanx.

• Boutonniere Deformity:– Caused by a rupture of

the extensor tendon dorsal to the middle phalanx.

Pollicis Injuries• Gamekeeper’s Thumb:

– A serious injury to the UCL (ulnar collateral ligament) of the thumb.

– Injury usually occurs when proximal phalange of the pollicis is forced into Abduction and sometimes hyperextension.

– Common in Skiers, football players.• De Quervain’s Syndrome

(Hoffman Disease) – Is usually a “chronic” injury to the

tendons of the pollicis.– Caused by a stenosing tenosynovitis in

the thumb.– Created by constant movement, causing

wear and tear, of the wrist.

“Hand” Injuries• Boxer’s Fracture:

– A Fracture to the 5th Metacarpal.– Common MOI is punching

something.• Scaphoid (Navicular) Fracture:

– Fracture to the Scaphoid bone– Most common bone fractured in

hand.– Common MOI involves FOOSH.– Due to the lack of blood supply,

it is more difficult for the bone to heal without proper care, and sometimes surgery.

“Hand Injuries”

• Fracture OR Dislocation of Lunate:– The Lunate bone sits next to the

Scaphoid bone, and it is also fractured at times.

– Dislocation of the lunate is also common and can be very painful.

• Fractured Hamate– The Hamate can be fractured

because of FOOSH.– Another common MOI is an athlete

making contact with something while holding a racket, club, bat, etc.

– Most of the time, the “Hook of the Hamate” is most vulnerable part of the bone.

Wrist Injuries• Colle’s Fracture:

– A Colle’s fracture most commonly results from a FOOSH mechanism.

– The opposite of a Colle’s fracture is a Smith’s Fracture.• Smith’s Fracture:

– A Smith’s fracture is a result of the Ulna and Radius bones translating the opposite direction(Palmar side of the hand).

Wrist Conditions

• Carpal Tunnel:– A condition in which the

“Median” nerve becomes compressed due to tightening of the space around the wrist.

– Mostly due to repetitive use of wrist in a flexed position.

• Wrist Ganglion Cyst:– A “Synovial Cyst”– Usually presents itself on the

back of the wrist, typically following a wrist injury.

– Can go away over time on its own, or the cyst can be either aspirated or surgically removed.

Injury QuizMATCHING

1. A break to the “navicular” bone of the hand.2. Opposite of “baseball finger”, a tearing of the flexor

tendon near the finger tip.3. Injury to the thumb that results in tearing or

stretching of the MP joint OR rupture of the ulnar collateral ligament(UCL).

4. The abnormal movement of one of the bones that constitute a joint out of place, but returns to it’s “normal” position.

5. An major injury to the lower arm bone, just proximal to the wrist. Wrist is in extension.

6. Displacement of ANY bone from it’s normal position.

7. Inflammation of tendons caused by overuse or repetitive motion.

8. Can involve any of the 3 bones in each finger.9. Fracture to the 5th metacarpal, on the “pinkie” side.10. An injury to the finger resulting from tearing of the

finger tendon and damage to the cartilage. (Also known as Mallet Finger or “basketball finger”)

A.Finger FracturesB. Baseball FingerC. Scaphoid FractureD.DislocationE. TendonitisF. Gamekeeper’s

ThumbG.SubluxationH.Colle’s FractureI. Jersey FingerJ. Boxer’s Fracture

Answers

1. C2. I3. F4. G5. H6. D7. E8. A9. J10. B