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HAND INJURIES, Linked Coggle - Coggle Diagram
HAND INJURIES
STRUCTURAL INJURY OF HAND
HAND & WRIST MUSCLES AND TENDON INJURIES
Tendonitis
Mechanism of injury:
Overuse
Stretching
Impact
Signs & Symptoms
Generalized Swelling
Tenderness
Inability to flex the wrist
Definiton : inflammation of the tendon
Mallet Finger
result of the
fingertip receiving an impact
causes the extensor
tendon to be torn.
fingertip will be
permanently in flexion.
Jersey Finger/ Tendon Tear
Flexor Digitorum Profundus (FDP) Tendon Injury
The FDP tendon tears or avulses (pulls off) from its attachment at the base of the distal phalanx.
cannot bend the fingertip (DIP joint).
Common Cause:
Often seen in football or rugby
an athlete grabs an opponent’s jersey, and the finger is forcefully extended while trying to actively flex
opposing force causes the tendon to snap off the bone.
Boutonniere Deformity
Occurs at the PIP joint of the finger.
Caused by a direct blow to the PIP joint.
tear the joint capsule and cause extensor tendons to slip sideways (laterally).
Result:
Athlete can flex the DIP joint,
cannot extend the PIP joint.
WRIST & HAND BONE INJURIES/FRACTURES
Colles Fracture
fracture at the distal end of the radius (near the wrist).
Happens when the hand is pushed backward
hard impact on the forearm can break the radius bone
break often occurs at a weak spot where the radius gets wider near the wrist.
Common causes
Fall on an outstretched hand
Motor vehicle accident
Any strong force on the hand.
Scaphoid Fracture
caused by
a fall on an outstretched hand
compressing the scaphoid between the radius and other carpal bones.
mistaken for a wrist sprain, leading to delayed treatment.
Sometimes, even with a splint, the fracture doesn’t heal and needs surgery
poor blood supply can cause avascular necrosis (bone death)
Signs & Symptoms:
Swelling in area of the carpal bones
Severe point tenderness in the
anatomical snuffbox
Pain elicited by upward pressure exerted on the long axis of the thumb and radial flexion
Metacarpal / Boxer’s
Fracture
Mechanism usually involves:
Striking an object
Having the hand stepped on
Signs & symptoms include:
Pain
Deformity
Swelling
Abnormal
mobility
LIGAMENT INJURIES
GAMEKEEPER’S THUMB
CAUSES
Forcefully abducted
fall or a direct hit to the tip of the thumb
injury to the medial collateral
ligament
INTERPHALANGEAL COLLATERAL LIGAMENT SPRAINS :
collateral ligament is located on the side of each interphalangeal joint
ligaments provide stability
when the phalanges are stressed.
mechanism of injury
if the athletes finger accidentally get caught in an opposing player jersey
tip of the finger hit by a ball
WRIST SPRAIN
CAUSES
overuse, falls, and
forceful twisting motion.
SIGN & SYMPTOMS
• Pain
• Decreased ROM (possibly)
• Decreased grip strength
• Swelling
DISLOCATED FINGERS
occur frequently in sports
mainly caused by blows to tip of the finger
bone usually moves dorsal and anterior
should relocate all dislocated finger and thumb because tiny, tendon, nerves and blood vessel
CUMULATIVE TRAUMA DISORDER
DE QUERVAIN’S TENOSYNOVITIS
inflammation of the tendon sheath in the 1st dorsal wrist compartment
Caused by
myxoid degeneration, not true inflammation
Leads to thickened tendon sheath
Traps APL and EPB tendons
Linked to repetitive wrist motion (thumb abduction + wrist radial deviation)
how it happen
1st Dorsal Compartment
Contains APL and EPB tendons
Surrounded by synovial sheath, separate from other compartments
tendons pass through a 2 cm fibrous tunnel over radial styloid
Prone to entrapment with trauma or repetitive motion
Clinical features and
Symptoms
gradual on set
radial side wrist sprain
fusiform swelling
tenderness overlaying the radial styloid
pain exacerbarted by gripping and raising object with wrist in neutral
Provocative tests
Finkelstein maneuver
Eichhoff maneuver
Diagnosis
clinical
Medical Management
nonsurgical
thumb spica splint
steroid injection
surgical
Decompression surgery of the 1st dorsal compartment
indicated if symptoms persist >6 months despite conservative treatment
Complications
Radial nerve injury
Neuroma
Incomplete decompression (missed EPB/APL subsheath)
Complex regional pain syndrome (CRPS)
prognosis
High recurrence rate
Most cases resolve with non-operative
management
TRIGGER FINGER
tenosynovitis of the flexor sheath, often affecting the thumb and 4th finger
etiology
Diabetes
Amyloidosis
Carpal tunnel syndrome
Gout
Thyroid disease
Rheumatoid arthritis
pathophysiology
Microtrauma/repetition → inflammation of flexor tendon sheath
A1 pulley most affected due to highest stress
tendon sticks in sheath, causing locking sensation
Flexion normal, but locking occurs during extension due to catching tendon
Clinical Features and Symptoms
Pain over the distal palm
Tenderness over the A1
pulley
Pain radiating along the
digit
Triggering on active or passive extension by the patient
grade
grade I
pain or history of catching
grade II
demonstrable catching, but can actively extend the digit
grade III
grade IV
fixed flexion contracture
demonstrable locking, requiring passive extension
Investigations and Diagnosis
The diagnosis of trigger finger is clinical
It is presumed in a patient whose finger locks during
flexion, clicks painfully, and catches upon extension
It is also presumed when an inflamed nodule at the
base of the affected finger is present
Medical Management
(Non-surgical)
Steroid Injection
splinting
Surgical
Gold standard: Open release of A1 pulley
Indicated if no improvement with splinting/injection or in irreducibly locked trigger finger
complications
steroid injections can cause
tissue atrophy
skin discoloration
hypopigmentation or even infection
prognosis
Injection with or
without splinting
Very good overall
Surgical
Very good outcome
Percutaneous release is safe and effective, with 74–94% success and no reported complications at follow-up
CARPAL TUNNEL SYNDROME
compression of the median nerve as it travels through the wrist's carpal tunnel
Most common causes
Genetic predisposition
History of repetitive wrist movements such as typing, or
machine work
obesity
Autoimmune disorders such as rheumatoid arthritis
Pregnancy
Pathophysiology
Compression of the median nerve in the carpal tunnel
increased pressure within the tunnel
Leads to reduced blood flow (ischemia) to the nerve
Causes nerve irritation and inflammation
Often due to repetitive wrist movement, swelling, or thickening of surrounding tissues
esults in pain, numbness, and tingling in the hand and fingers
Clinical Features
numbness or tingling in the fingers (excluding the little finger)
Weakness of the thumb or difficulty gripping objects
Pain in the fingers
pain may radiate from the hand to the elbow
Investigations & Diagnosis
MRI: Detects space-occupying lesions (pre-op).
Ultrasound: Identifies lesions, nerve changes, guides injections.
EMG & NCS: Confirms diagnosis, assesses severity & prognosis.
Complications
Post-Surgery:
Dysesthesia
Hypertrophic scar
Neuroma (median nerve branch)
Persistent symptoms
wrist stiffness
due to CTS
Permanent nerve damage
henar muscle atrophy & weakness
Prognosis
CTS can worsen over time, causing permanent nerve damage
Recurrence after surgery in up to 1/3 of patients within 5 years
90% of mild–moderate cases improve with conservative treatment
Worse prognosis if due to diabetes, fracture, or normal nerve tests
Axonal loss indicates poor outcome
Medical Management
Non-surgical:
Wrist splint to keep wrist straight, especially at night
Reduce repetitive movements which cause strain
Alternative treatments such as yoga, acupuncture, and hand
exercises
Median nerve gliding
Ergonomic modification,
Postural training
Steroid injections
surgical
Carpal tunnel release
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