Wrist / Fingers Injuries

Siti Sakinah Ab. Jalil AP090208

Tan Mei Jing AP090244

Thong Shwu Huan AP090221

Nurul Rafeeda Saarani AP090164

Noradibah Abdullah AP090117

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

Causes1. 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

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

resistance against

flexion of the fingers

as a functional

• Applying manual

resistance againts

extension of the

metacarpophalangeal

joints

Applying manual resistance againts flexion of an

individual finger. A, proximal interphalangeal (PIPP)

joint and B, distal interphalangeal (DIP) joint.

A B

• Applying manual

resistance against

extension of all the

fingers

• Applying manual

resistance against

extension of the

metacarpophalangeal

joints

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

A B

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 (OrudisKT).

• Acetaminophen (Tylenol and Panadol).

• Prevention for sprained thumb

– Rest

– Taping

– Apply Ice

– Compress with a compression support bandage.

Thank You