Wrist/Hand

1. Wrist/Hand Sports Med

2. Articulations • Radiocarpal • Flexion, extension, abduction, and circumduction • Carpal • Gliding joints • Stabilized by anterior, posterior, and connecting ligaments • Metacarpal • Flexion, extension, abduction, adduction, circumduction • Phalangeal • Hinge joints • Proximal interphalangeal (PIP), Distal interphalangeal (DIP)

3. Ligaments • Wrist • Ulnar Collateral ligament • Ulna to pisiform • Radial collateral ligament • Radius to scaphoid • Transverse carpal ligament • Roof of the “carpal tunnel” • Phalanges • Collateral ligaments

4. Muscles • Flexors • Palmar surface • Flexor digitorumsuperficialis, flexor digitorumprofundus • Extensors • Dorsal surface • Extensor digitorumlongus, • Intrinsics • Abduction and adduction

5. Blood/Nerve Supply • Nerves • Ulnar, radial • Median • Enters palm through carpal tunnel • Arteries • Radial • ulnar

6. Assessment • History • MOI • Location and type of pain? • Increases or decreases pain? • History of trauma or overuse? • Any therapy given in the past?

7. Assessment • Observations • Hand usage like writing, unbuttoning shirt • Open and close hand • Fully? Rythmically? • Touch thumb to each fingertip • Flat knuckle • Color of fingernails • Pale= poor circulation

8. Assessment • Palpations • Bony • Scaphoid (anatomical snuffbox) • Lunate • Hamate (hook) • Metacarpals • Phalanges (proximal, middle, and distal) • Soft • Triangular fibrocartilage (TFCC) • Collateral ligaments of phalanges • Flexor and extensor muscles

9. MMTs • Flexion • Extension • Ulnar deviation • Radial Deviation • Finger Abduction • Finger Adduction

10. Tenosynovitis • MOI • Repetitive use and overuse of tendons and their sheaths • S/S • Pn with use, pn w/passive stretching • Tenderness, swelling over tendon • TX • Ice massage, NSAIDS, rest • ROM, contrast baths, US, PRE

11. Carpal Tunnel Syndrome • MOI • Inflammation in the carpal tunnel, compresses median nerve • Repeated flexion, or direct blow • S/S • Tingling, numbness, weakness • TX • Rest, immobilization, NSAIDS • Possible surgery

12. Finkelsteins Test http://youtu.be/lXV_UV62USc • Procedure • Athlete is sitting, forms a fist around the thumb. • Examiner grasps the athlete's forearm and fist and ulnarly deviates • Positive Test • Pn. = Possible tenosynovitis • Pn. At carpal tunnel = carpal tunnel syndrome

13. Phalens Test http://youtu.be/DZ9UGuA8oAE • Procedure • Have athlete flex both wrists as far as possible and press together for 1 minute • Positive Test • Pn. At the carpal tunnel = carpal tunnel syndrome

14. Wrist Sprains (most common) • MOI • Falling on hyperextended wrist • Violent flexion or torsion • S/S • Pn, swelling, decreased AROM • TX • RICE, splinting, analgesics • Tape, strengthening

15. Gamekeepers Thumb • MOI (skiiers, tacklers) • Sprain of UCL ligament of MCP joint of thumb • Forceful abduction with hyperextension • S/S • Pn, weak pinch, • Tenderness and swelling • TX • Refer • Splint 3 weeks

16. Glide Test http://youtu.be/YrJ98IYsgBw • Procedure • Grasp the athletes wrist with one hand and their carpals with the other • Move anterior/posterior and radial/ulnar directions • Can also do on each phalange/metacarpal joint • Positive Test • Pn./laxity = sprain

17. Valgus/Varus • Procedure • Examiner maintains stabilization of the proximal bone between the thumb and forefinger and grasps the distal bone • Examiner provides a valgus/varus force • Positive Test • Pn./laxity = collateral ligament tear/sprain

18. Triangular Fibrocartilage Complex Injury (TFCC) • MOI • Forced hyperextension • S/S • Pn along the ulnar side of wrist • Extension = pn, difficulty • Swelling later on • TX • refer

19. ScaphoidFx (most common) • MOI • FOOSHA, compresses scaphoid between radius and carpals • S/S • Point tenderness in snuff box • Pn. With thumb compression and radial flexion • TX • Splint and refer for x-ray • Untreated leads to necrosis

20. Hamate (hook) Fx • MOI • Direct blow from racket, bat, sports stick, club • S/S • Wrist pn and weakness • Point tender • TX • Refer for x-ray • Doughnut pad

21. CollesFx • MOI • Fx to distal end of radius or ulna • FOOSHA, or hyperextension • S/S • Visible deformity • Swelling and pn • TX • Ice and splint • refer

22. Boxers (5th metacarpal) Fx • MOI • Direct axial force (punching) • Getting stepped on • S/S • Pn and swelling • TX • RICE, analgesics, refer • Splint 4 weeks, early ROM

23. Compression Test • Procedure • Athlete has finger extended • Examiner holds the distal phalanx and applies compression along the axis of the bone of the finger being tested • Can also be done on metacarpal in fist position • Positive Test • Pn at injury site = possible fx

24. Allens Test http://youtu.be/jq0ai5uXx68 • Procedure • Athlete squeezes hand into a fist and fully opens hand 3-4 times • With athlete holding the last fist the evaluator puts pressure over radial and ulnar artery • Athlete opens hand (appears white), evaluator releases 1 artery and the hand should become red • Positive Test • Not turning red instantly = radial or ulnar artery compromise

25. Mallet Finger • MOI • Direct blow to extended finger • S/S • Pn at DIP • unable to extend finger • TX • RICE • Splinted 24 hr/day, 6-8 weeks

26. Boutonniere Deformity • MOI • Trauma forcing the DIP into extension and PIP into flexion • S/S • Pn and inability to extend the DIP • Swelling, obvious deformity • TX • Ice • Splint PIP in extension5-8 weeks • Flex distal phalanx

27. Jersey Finger • MOI • Most often in the ring finger • Grabs a jersey, ruptures flexor tendon • S/S • DIP joint cant be flexed • Finger stuck in extension • TX • No surgery = never flex DIP again • Surgery = 12 weeks of rehab

28. Tap/Percussion Test • Procedure • Athlete extends affected finger • Evaluator applies a firm tap to the end of the finger • Positive Test • Pn. At injury site = possible fx