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HAND INJURIES, Signs & Symptoms, Special Tests (Provocative Tests,…

- - - - Jersey Finger/ Tendon Tear
        
        Jersey finger is when the tendon that bends the fingertip gets torn.
        
        It usually happens in sports when the finger is bent and suddenly pulled straight.
        
        The person can’t bend the tip of the finger anymore
      - Boutonniere Deformity
        
        Occurs at the PIP joint of the finger.
        
        A strong hit to the middle finger joint (PIP joint) can tear the joint capsule.
        
        When this happens, the extensor tendons slide out of place (to the side).
      - Tendonitis
        
        inflammation of the tendon.
        
        Mechanism of Injury
        
        Impact – a direct hit or blow to the wrist or hand
        
        Overuse – repeated movements over time
        
        Stretching – excessive pulling of muscles or tendons
        
        Signs & Symptoms
        
        Difficulty or inability to bend (flex) the wrist
        
        Tenderness when touching the area
        
        Swelling around the wrist
      - Mallet Finger
        
        Mallet finger is caused by a hit to the fingertip.
        It damages the tendon, and the finger stays bent down because it can’t straighten
  - - - Occur from overuse, falls, and
        forceful twisting motion
    - - Phalange injuries often happen in sports and are usually caused by a direct hit to the tip of the finger
        
        If the finger joint pops out of place, one bone moves backward and the other moves forward
        
        Dislocated fingers and thumbs should be put back in place by a doctor because they can damage small tendons, nerves, and blood vessels.
        
        If the dislocation is not fixed properly, it can cause permanent damage to the finger
    - - An ulnar collateral ligament (UCL) injury of the thumb is when the ligament on the inside of your thumb gets stretched, torn, or damaged.
        It usually happens when the thumb is pulled too far back or to the side, like during a fall or while playing sports
        
        known as Skier’s thumb due to the
        high incidence of medial collateral
        thumb injuries in skiing.
        
        The thumb can be injured when forcefully abducted
        
        The thumb can be injured in a fall or direct hit to the tip of the thumb
    - - Located on the side of each interphalangeal joint
        
        The ligaments help keep the finger bones steady when they are under pressure or force
        
        Example
        
        tip of the finger hit by a ball, or
        
        finger accidentallygets caught in a opposing playersjersey
  - - - a break of the end of the radius bone.
        
        Colles Fracture Mechanism
        
        The wrist can break if you fall or are in a car accident.
        
        Any strong force on the hand can cause the wrist bones to break.
        
        The wrist can be broken from a sudden force pushing the hand backwards
    - - break in the neck of the 5th metacarpal bone which the bone below the little finger.
        
        Causes:
        Punching a hard object
        
        Symptoms
        
        Swelling on the outer side of the hand.
        
        Deformity
        
        Bent or shortened little finger.
        
        Pain
    - - break in the scaphoid bone, one of the small bones in your wrist. It is located near the base of the thumb, and is the most commonly fractured carpal bone.
        
        Symptoms
        
        Pain when gripping or moving the thumb.
        
        Tenderness in the anatomical snuffbox
        
        Pain and swelling on the thumb side of the wrist.
        
        TREATMENT
        
        Non-displaced fracture: Cast immobilization (thumb spica cast).
        Displaced or unstable fracture: Surgery with screws or pins.
  - - - WRIST SPRAINS
        
        Treatment includes the P.R.I.C.E. method (Protection, Rest, Ice, Compression, Elevation), followed by restoring range of motion and strength through gentle exercises, and using a tape or brace when returning to sports.
        
        Gamekeeper’s Thumb (Skier’s Thumb) /
        Ulnar Collateral Ligament Tear
        
        Interphalangeal Collateral Ligament Sprains
        
        Treatment includes X-ray to rule out fracture, ice to reduce swelling, splinting when not playing, and buddy taping to the next largest finger during activity.
        
        FINGER DISLOCATION
        
        Treatment involves splinting the dislocation, applying ice to reduce swelling and pain, referring to a physician for reduction and X-ray, and maintaining the splint for about 3 weeks in 30° flexion.
        
        Splint the medial thumb and apply ice; an X-ray is needed to check for avulsion fracture, which may require surgery if present.
    - - Tendonitis
        
        Treatment includes the P.R.I.C.E. method (10–15 minutes on, 1–2 hours off), followed by gradual use of heat and starting hand-strengthening exercises.
        
        Mallet Finger
        
        Apply an ice bag and splint the finger in extension, then refer to a physician who may choose surgery or continued splinting—without proper treatment, it can lead to permanent DIP joint flexion.
        
        Jersey Finger/
        Tendon Tear
        
        Apply splint and ice, send for an X-ray and doctor’s evaluation, and the physician will decide if surgery or continued splinting is needed.
        
        Boutonniere Deformity
        
        Splint the finger and refer to a physician, as many cases heal with splinting to support the extensor tendons, though surgery may be needed in some situations.
    - - Colles Fracture
        
        Apply ice, splint, and use a sling while treating for shock; a doctor will usually X-ray and cast the injury, but severe fractures may require surgery with pins, screws, or wires.
        
        Scaphoid Fracture
        
        Apply ice and splint, refer for an X-ray, followed by casting for about 8 weeks, then begin strengthening and taping after cast removal.
        
        Metacarpal / Boxer’s Fracture
        
        Apply ice, splint using a roll of gauze in the palm, and refer to a physician for X-ray and proper treatment.
- - - - Etiology (Causes)
        occurs due to increased pressure within the carpal tunnel, leading to compression of the median nerve, and is commonly caused by genetic predisposition, repetitive wrist movements (like typing or machine work), obesity, autoimmune disorders such as rheumatoid arthritis, and pregnancy.
        
        Pathophysiology
        .
        
        Clinical features
        numbness or tingling in the fingers except the little finger, weakness in the thumb or difficulty gripping, and pain that may extend from the fingers to the arm between the hand and elbow.
        
        Investigations
        MRI and ultrasound to detect space-occupying lesions and nerve abnormalities, while electromyography (EMG) and nerve conduction studies (NCS) are the gold standard for diagnosis, helping to assess the severity and prognosis of the condition.
        
        Investigations
        Special tests
        
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        Medical management
        wrist splinting, reducing repetitive movements, ergonomic and postural training, median nerve gliding exercises, alternative therapies like yoga or acupuncture, steroid injections, and in some cases, non-surgical carpal tunnel release.
        
        Complications
        
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        Compressive Mechanism in Carpal Tunnel Syndrome (CTS):
        
        Increased pressure inside the carpal tunnel
        
        Blocked blood flow (veins) → causes swelling (congestion)
        
        Fluid builds up (edema) in the area
        
        Less blood supply to the median nerve
        
        Effect of Repetitive Wrist Motion & Traction
        
        Increases friction and strain on the nerve and tendons
        
        Causes continuous microtrauma and inflammation
        
        Worsens compression-related changes in the carpal tunnel
        
        Leads to more damage to the median nerve and surrounding soft tissues
        
        Combined Compression & Traction Effects
        
        CTS results from both compression and traction forces.
        
        The carpal tunnel contains 9 flexor tendons and the median nerve.
        
        When these tendons are inflamed (tenosynovitis), they take up more space and press on the median nerve.
        
        Sensory fibers (touch and pain) are affected before motor fibers (movement).
        
        Autonomic fibers may also be involved, leading to dryness or abnormal sweating in the hand.
  - - - Etiology
        commonly caused by repetitive movements of the wrist and thumb, such as lifting, gripping, or texting. It may also occur due to overuse injuries, direct trauma to the wrist, or inflammatory conditions like rheumatoid arthritis. Hormonal changes, especially during pregnancy, can also contribute. This condition is more commonly seen in women aged 30 to 50.
        
        Pathophysiology
        
        Inflammation of the tendon sheath in the 1st dorsal compartment
        
        Caused by repetitive thumb/wrist motion
        
        Leads to swelling and narrowing of tendon tunnel
        
        Results in pain, limited thumb movement, and friction
        
        Clinical Features
        
        Swelling near thumb base
        
        Thumb-side wrist pain
        
        Tender over radial wrist
        
        Pain with grip or thumb movement
        
        Investigations
        
        Range of Motion (ROM)
        Wrist movement usually normal
        Pain on resisted radial deviation
        
        Inspection & Palpation
        Tenderness at the 1st dorsal compartment near the radial styloid
        
        Neurovascular
        Normal sensation and blood flow
        
        Medical Management (Surgical)
        
        Procedure: Release of the 1st dorsal compartment
        
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        Complication
        
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  - - - Etiology
        often linked to conditions like diabetes, rheumatoid arthritis, gout, and thyroid disease, and can also be caused by repetitive or traumatic hand use, which leads to thickening of the tendon or sheath, causing the finger to catch or lock during movement.
        
        Pathophysiology
        
        Repetitive use or compression causes microtrauma to the flexor tendon-sheath complex.
        
        The A1 pulley is most commonly affected due to high stress.
        
        Inflammation leads to tendon thickening and sticking within the sheath.
        
        Patients can flex the finger, but face locking or catching during extension.
        
        This occurs because the flexor tendon is stronger than the extensor tendon.
        
        Clinical Features & Symptoms
        
        Locking or catching during finger movement (flexion-extension)
        
        Stiff finger, especially in chronic cases
        
        Pain over distal palm or radiating along the finger
        
        Triggering during active or passive extension
        
        Snapping or crepitus felt over A1 pulley
        
        Tenderness at A1 pulley area
        
        Palpable nodule near MCP joint in palm
        
        Fixed flexion deformity (late stage, especially PIP joint)
        
        May affect multiple fingers or both hands (bilateral)
        
        Investigations and Diagnosis
        
        Primarily a clinical diagnosis
        
        Based on history of painful clicking or locking during finger movement
        
        Catching sensation upon extension
        
        Presence of a tender nodule at the base of the affected finger (A1 pulley region)
        
        Medical Management
        
        NON SURGICAL
        
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        COMPLICATIONS
        
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        SURGICAL
        
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- - - - Clinical features of flexor tendon injuries include loss of active flexion in the affected finger, numbness due to possible nerve damage, and white or purple discoloration if a blood vessel is injured, which is a medical emergency.
        
        Investigations for flexor tendon injuries include a physical examination to assess finger flexion and tendon continuity, an X-ray to rule out bone injury, and ultrasound or MRI to evaluate tendon integrity if necessary.
        
        Complications of flexor tendon injuries may include tendon adhesions, re-rupture (around 20% risk), joint stiffness or contracture, bowstringing, and deformities like trigger finger or swan neck.
        
        The prognosis for flexor tendon injuries is generally good, as most patients regain function with early surgery and consistent rehabilitation, and outcomes have improved significantly with controlled mobilization protocols.