Chapter 15 The Wrist, Hand, and Fingers

1
Chapter 15 The Wrist, Hand, and Fingers

• Pages 556 - 559

2
Hand Pathology

• Most injuries have acute onset
• Hyperflexion/hyperextension of wrist
• Axial load of metacarpal bones
• Crushing forces

3
Scaphoid Fractures

• Bony block for wrist extension
• Blood supply
• Receives from distal end
• Fracture may compromise nutrition to proximal
  end
  
• High incidence of nonunion or malunion fractures
  secondary to avascular necrosis
  
• Figure 15-27, page 557

4
Scaphoid Fractures

• Preisers Disease
• Osteoporosis of scaphoid due to fx or repeated
  trauma
  
• Signs and Symptoms
• Aching pain in anatomical snuffbox area
• Grip strength decreased
• Evaluative Findings
• Table 15-9, page 558

5
Scaphoid Fractures

• Pain in anatomical snuffbox area after
  hyperextension mechanism should be treated as
  scaphoid fracture
  
• Treatment
• Immobilization of wrist and thumb
• Referral to physician
• Fx may not be visible on x-ray right away

6
Scaphoid Fractures

• Conservative Treatment
• Short arm thumb spica cast
• Long arm thumb spica cast
• Eliminates pronation and supination
• May decrease risk of non- and malunions
• Surgical Treatment
• Displaced fractures
• Some may chose to immediately fixate fracture
• After healing phase, ROM and strengthening

7
Perilunate and Lunate Dislocation

• Series of events
• As limits of wrist/hand extension are exceeded
  scaphoid strikes radius
  
• Rupturing of volar ligaments that connect
  scaphoid to lunate
  
• As force continues, distal carpal row is stripped
  away from lunate
  
• Lunate rests dorsally relative to other carpals
• This is a Perilunate Dislocation

8
Perilunate and Lunate Dislocation

• Series of events cont.
• Further extension leads to rupture of dorsal
  ligaments
  
• This relocates the carpals and rotates the
  lunate
  
• Lunate rests volarly relative to other carpals
• This is a lunate dislocation
• Either dislocation may spontaneously reduce

9
Perilunate and Lunate Dislocation

• Signs and Symptoms
• Pain along radial side of palmar or dorsal aspect
  of wrist that limits ROM
  
• Bulge may be visible on dorsal or palmar aspect
  proximal to third metacarpal
  
• Paresthesia in middle finger
• Fracture of scaphoid should be suspected

10
Perilunate and Lunate Dislocation

• Evaluative Findings
• Table 15-10, page 558
• Kienbocks Disease
• Osteochondritis or slow degeneration of lunate
• Due to repetitive trauma that may compromise
  vascular supply
  
• May result in loss of ulnar deviation,
  tenderness, pain, swelling, decreased grip
  strength
  
• Characteristic pain during passive extension of
  third finger

11
Perilunate and Lunate Dislocation

• Treatment
• Closed reduction and immobilization in flexion
  for 6-8 weeks
  
• Frequent follow-ups
• Pinning may be needed if reduction is lost

12
Metacarpal Fractures

• Common for athlete to hear the bone snapping as
  it fractures
  
• Immediate pain
• Gross deformity may be visible or obscured by
  swelling (Figure 15-28, page 559)
  
• Palpation reveals tenderness, crepitus, false
  joint
  
• Evaluative Findings
• Table 15-11, page 560

13
Metacarpal Fractures

• Long bone compression test
• Figure 15-29, page 559
• Boxers fracture
• Fifth metacarpal
• Depressed 5th MCP joint

14
Metacarpal Fractures

• Treatment
• If no rotation casting
• With rotation open reduction with internal
  fixation
  
• After healing phase ROM and strengthening
  (approximately 8 weeks after fracture)