Metacarpals

1
Metacarpals

• Palpated in order
• Numbered 1 -5
• Starting at thumb
• Palpate the entire length

1st Metacarpal
Trapezium
1st Metacarpal

• From Snuffbox to MCP Joint
• Shorter and broader than other metacarpals

2
Metacarpal Fracture

• Fracture tests
• Palpation
• Compression
• Axial compression
• Percussion
• Management
• RICE
• Analgesics
• X-ray examination
• Deformity is reduced
• Splinting
• 30 degrees of flexion
• 4 weeks

• Etiology
• Direct axial force or
• Compressive force
• 5th metatarsal
• Boxing or martial arts
• (boxers fracture)
• Signs and Symptoms
• Pain
• Swelling
• Crepitus
• Possible deformity
• angular
• rotational

3
Phalangeal Fractures
Proximal Fracture
Middle Fracture

• Etiology
• Direct trauma
• Twist
• Signs and Symptoms
• Pain
• Swelling
• Deformity
• Crepitus

• Management
• RICE
• Proximal Fracture
• Splint
• Buddy taping
• Middle Fracture
• No deformity
• Buddy tape w/ thermoplastic splint for activity
• Deformity
• Immobilization for 3-4 weeks
• Protective splint for an additional 9-10 weeks
  during activity

4
Distal Phalangeal Fracture

• Management
• RICE
• Protective splint
• 0º flexion

• Etiology
• Crushing force
• Signs and Symptoms
• Pain
• Swelling
• Crepitus
• Subungual hematoma

5
Joints

• Metacarpophalangeal Joint
• Proximal Interphalangeal Joint
• (PIP Jt.)
• Distal Interphalangeal Joint
• (DIP Jt.)
• Interphalangeal Joint
• Thumb (IP)

6
IP Joint Anatomy
Middle Phalange
Collateral Ligament
Accessory Ligament
Volar Plate
Checkrein Ligament
Collateral Ligament
Accessory Ligament
Distal
Middle Phalange
Proximal Phalange
Volar Plate
Proximal
7
IP Joint Sprains

• Etiology
• Fingers are prone to sprains
• Direct blows or twisting
• Occurs w/ axial loading or
• Valgus/varus stresses
• Similar to fractures and dislocations
• Injury can damage
• Collateral ligaments
• Volar plate

• Special Tests
• Fracture tests
• Radial and Ulnar deviation
• Assess collateral ligaments
• Anterior and posterior glide tests
• Assess joint capsule

8
Interphalangeal Joint Sprains

• Management
• RICE
• X-ray examination
• PIP sprain
• 30 - 40º flexion
• 10 days
• DIP Sprain
• Splint for a few days
• Full extension
• Taping

Collateral Ligament
Volar Plate
9
Metacarpophalangeal Joints
(MC-P Joints)
Head of 2nd Metarsal

• Assessment
• Place joint in full flexion
• Radial deviation
• Ulnar deviation
• Rotation

• Palpation
• Place joint in flexion
• Joint exposed better
• Groove for extensor tendon

10
PIP and DIP Dislocations

• Etiology
• Hyperextension Dorsal PIP
• Axial load on a partially flexed DIP joint

• Management
• RICE
• Reduction by MD
• Post reduction splinting
• Buddy taping
• Begin motion at 3 weeks
• Large bone fragments splint 30-60º flexion
• Small bone fragments buddy taping

• Signs and Symptoms
• Obvious deformity
• Swelling
• Possible avulsion volar plate
• Possible fracture

11

Mallet Finger (baseball or basketball finger)

• Etiology
• Caused by a blow that contacts tip of finger

Jersey Finger

• Etiology
• DIP joint injury
• Rupture of flexor muscle
• Common injury to football lineman

12
Subungual Hematoma

• Bruising bleeding under fingernail
• Extremely painful due to build-up of pressure
  under nail
• Pressure must be released once hemorrhaging has
  ceased
• Release as distally as possible
• Bandage with antibiotic ointment
• Hot paper clip
• Finger nail drill
• Scalpel