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)

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

Muscles• Flexors– Palmar surface– Flexor digitorum superficialis, flexor

digitorum profundus• Extensors– Dorsal surface– Extensor digitorum longus,

• Intrinsics– Abduction and adduction

Blood/Nerve Supply

• Nerves– Ulnar, radial– Median• Enters palm through carpal tunnel

• Arteries– Radial– ulnar

Assessment

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

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

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 musclesUse hand flashcards for palpation practice

MMTs• Flexion• Extension• Ulnar deviation

– 5th digit moves towards ulna

• Radial Deviation– Thumb moves towards

radius

• Finger Abduction – Fingers spread out

• Finger Adduction– Fingers back together

Perform Active, passive, resistive of all movements on ALL fingers

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

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

Finkelsteins Testtests for de Quervain’s disease

• 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 (de Quervain’s disease)

– Pn. At carpal tunnel = carpal tunnel syndrome

http://youtu.be/lXV_UV62USc

Phalens Test

• 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

http://youtu.be/DZ9UGuA8oAE

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

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

Glide Test

• 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

http://youtu.be/YrJ98IYsgBw

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

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

Scaphoid Fx (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

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

Colles Fx

• MOI– Fx to distal end of radius or ulna– FOOSHA, or hyperextension

• S/S– Visible deformity– Swelling and pn

• TX– Ice and splint– refer

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

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

Allens Test

• 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

http://youtu.be/jq0ai5uXx68

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

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

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

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