Wrist / Fingers Injuries

DR.SHAFAQ SHAHID
LECTURER
DPT,MS-OMPT
Anatomy
Left picture:
deep palmar
view/ volar
view

Right
picture:
dorsal view/
 Anatomy of Wrist
• The hand is made of 10 bones:
8 carpal bones and 2 forearm bones
• the wrist is variously defined as the carpus
or carpal bones, the complex of eight bones
forming the proximal skeletal segment of
the hand
 Finger
• Ligaments, tendons, and
phalanges (digital bones).
• 14 phalanges, or phalanx bones:
– 2 in the thumb
– and 3 in each of the four
fingers
• distal phalanx
• the middle phalanx, and
• the proximal phalanx.
• Each finger also has 3 joints
which are
• the distal inter-
phalangeal (DIP)
• the proximal inter-
phalangeal (PIP)
• the metacarpo-
phalangeal (MP)
• Movements of fingers involved:
– Flexion and extension all the three joints
– Abduction and adduction (side-to-side movement) at the
metacarpo-phalangeal joint
• Flexion at the :
– DIP joint and PIP joint
• Abduction and adduction (side –to-side) at
metacarpophalangeal joint is produced by palmer and
dorsal interossei muscles.
• Extension of all the joints is caused by extensor
digitorum muscle.
 Wrist Injuries
（Lunate Dislocation)
• Dislocation : bone out from the original
position.
• Lunate dislocation: lunate bone come out
from the original position.
• A fall from a height or hit cause this
condition.
 Symptoms of Lunate Dislocation

• Wrist swelling, redness

• Movements of the wrist are often painful and
limited
• Grip strength in the hand will decreased.
• Numbness in the fingers
Scenario
 Assessment(Physical Examination)
• Know the athletes/sports
- knowing the types of injuries that are associated
with a particular sport.
- Identifies how was the injuries occur.
• Palpation
- Define the painful area/injuries part.
- Determine the bone.
 Diagnosis

• X-ray
• MRI
 Treatment for Lunate Dislocations

• Keep the person warm with blankets

to decrease the possibility of shock.

• Cut away clothing or remove the

sport equipment if possible, but don't
move the injured area .

• Immobilize the wrist joint and the

hand with padded splints.
• Follow instructions for R.I.C.E., the first
letters of rest, ice, compression and
elevation.
 Kienbock's disease

• Is a situation in which one of the small bones of the

wrist loses its blood supply and dies
• causing pain and stiffness with wrist motion
• usually progresses slowly over many years.
 Wrist Fracture
Scaphoid Fracture Colles’ Fracture
 Wrist Fracture
• Fracture : A disruption in the continuity of a
bone / broken bone

• Colles’ fracture: fracture of the radius, just

proximal to the wrist
 Colles’ fracture

• occurs at near the end of the radius

• 1 inch (2.54 cm) proximal to the radio-
carpal joint
Scenarios
 Causes
1. A blow to the wrist. A sudden force
pushing the hand backwards.
2. A strong force pushing the hand into the
forearm
3. A fall onto an outstretched wrist.

4. Extreme twisting of the wrist

 Sign and Symptoms

• Deformity of the wrist.

• Pain and swelling.

• Limited motion in the thumb or wrist.
 Treatment and prognosis

• Ice
• Elevate the fractured wrist
• Place it in a sling
• Immobilization with a rigid cast
• X-ray
• Surgery if required
 Neurovascular Assessment
• Check the ability to flex and extend each
interphalangeal joint.
• Abduction and adduction of fingers
• The sensation at the tip of each finger and
the thumb.
• Inspect the limb for swelling and compared
with unaffected side.
 Complications
• Limitations of movement

• Osteoarthritis
>>> changes in the joint alignment after the
bone is healed
 Peripheral nerve injuries

•Carpal tunnel syndrome

Stages:
Stage 1: pain, morning stiffness, no
localization of median nerve.
Stage 2:tingling, numbness, pain, paraesthesia,
localized to area of median nerve.
Stage 3:clumsiness, impairment of digital
function
Stage 4:wasting of thenar eminence
 Special Tests

Tinel’s
Phalen’s
 cock up splint

carpal tunnel syndrome

 Tendon and tendon sheath
injuries

Tenosynovitis:
De Quervain's disease

Finkelstein test
Abductor pollicis longus
Extensor pollicis brevis.
Finkelstein's test for
DeQuervain's tenosynovitis
 Extensor tendon injury-Mallet
finger

Tear or stretch of extensor

tendon prior to insertion on
distal phalanx
Exam: Soft tissue swelling,
lack of full extension of
DIPJ
 Mallet finger

X-ray may show lack of full extension with or without a

fracture of proximal aspect of distal phalanx
Strict immobilization in full extension 6-8 weeks
 Fingers Injury :
Strain
Strain : injury to the tendon or muscle

Causes :
overstretching, or forcing the
musculotendinous unit beyond its
normal ROM.
 Symptoms :

• pain on active and resistive contraction or

passive stretching of the musculotendinous
unit.
 Trigger Finger

Finger tendon disruption >>> prevent

the joint from extending
Strain may occur to the intrinsic muscles
of the hand because of excessive
overuse.
Mostly happens often in sport
requiring constant gripping like
rowing or gymnastics.
 Symptoms :

- Difficulties in straighten the fingers

- Cramping
- Fatigue of the involved muscles
- Increase in pain against resistive movement.
Assessment : Movement Procedures

1) Active movements
-Evaluate the ROM (usually evaluated
en masse)
-to begin assessing the integrity of
specific contractile
 2)Resistive Movements

-Apply resistance against the same

movements to further assess the bintegrity
of the contractile units.
• Applying manual • Applying manual
resistance against resistance againts
flexion of the fingers extension of the
as a functional metacarpophalangeal
joints
 A B

Applying manual resistance againts flexion of an

individual finger. A, proximal interphalangeal (PIPP)
joint and B, distal interphalangeal (DIP) joint.
• Applying manual • Applying manual
resistance against resistance against
extension of all the extension of the
fingers metacarpophalangeal
joints
 A B

Applying manual resistence against A, finger abduction and B, finger adduction

 Fingers Injury : Sprain
Sprain : injury to the ligament tissues

Symptoms:
 Tenderness
 Increase in pain
 Swelling
 Stiffness
 Soreness
 Example :
Gamekeeper’s/Skier Thumb = A sprain
of the ulnar collateral ligament of the
MCP joint of the thumb.

- Normally, sprained
ligament provides the
stability necessary for normal grip and
pinch.
 Injury Characteristics :

Local tenderness over the ligament

 Joint effusion
Increased pain on attempted abduction of
the thumb.
Instability will be present if the ligament is
torn.
 Assessment :
Movement Procedures:

>>> Apply stress to various structures in

and around the injury site in an attempt to
implicate or rule out involvement of
specific anatomic structures.
 Active Movements :

i) To evaluate the Range of Motion(ROM)

ii) To begin assessing the integrity of

specific contractile units.
 How :

- Instruct the athlete to execute each

movement through the greatest ROM
possible and tell any sensations or symptoms
that he/she experiences.

- Ask the athlete to perform each of the

motions, and then observe the movement.
Figure 19-23 : ROM of the
Thumb
 2) Resistive Movements
-Apply resistance against these same
movements to further assess the integrity of
the contractile units.
-Manual resistance against each of these
motions can assist in accurately identifying
specific painful areas and in comparing
muscular strengths between extremities.
 Thumb tests :
i) To test the
interphalangeal joint of
the thumb, stabilize the
proximal
phalanx and resist
flexion on the
distal phalanx.
ii) To test thumb adduction, reverse your
resistance to the medial border of the
proximal phalanx and instruct the athlete
to adduct the thumb.
iii ) To test opposition of the thumb, instruct
the
athlete to touch the top of the little finger
with the tip of the thumb. Then apply
resistance to the palmar surfaces of the
thumb and little finger.
 Prevention for Dislocation
and Fracture
• Build strength and muscle consistently
• Wear appropriate protective gear/ equipment.
• Avoid from falling down
• Avoid playing when very tired or in pain.
• Use the appropriate skills or techniques.
• Adequate calcium intake.
• Apply Cold therapy/Cryotherapy
• Exercise (wrist)
– Spread your fingers apart and close them several times.
– Imitate a typing action and do this as fast as you can.
– Place your hand palm down on a table and lift each
finger in turn.
– Squeeze a rubber ball, hold for a count of ten and
release the grip.
• Advanced exercises
– Throw a ball against a wall and build up to throwing a
ball with a partner gradually using more distance in
between.
– Use a racquet, golf club or other equipment to practice
strokes before returning to your sport.
• Rest
• Take anti-inflammatories e.g corticosteroids or
lidocaine injections
• Take over-the-counter pain medications.
• NSAIDs (nonsteroidal anti-inflammatory drugs).
These include aspirin, ibuprofen (Advil and Motrin),
naproxen sodium (Aleve), and ketoprofen (Orudis
KT).
• Acetaminophen (Tylenol and Panadol).
• Prevention for sprained thumb
– Rest
– Taping
– Apply Ice
– Compress with a compression support bandage.
Thank You