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OTCC 2033: Hand Injuries, Distal radius fracture (fall on outstretched…
OTCC 2033: Hand Injuries
Structural Injuries of the Hand
Ligament Injuries
Wrist Sprains
Caused by overuse, falls, twisting
Symptoms: pain, swelling, decreased ROM & grip strength
Treatment: PRICE, ROM/strengthening, taping for support
Gamekeeper's Thumb / Skier’s Thumb
Injury to ulnar collateral ligament of thumb
Mechanism: forceful abduction (e.g., skiing, falls)
Treatment: Splint, ice, X-ray, surgery if avulsion fracture
Interphalangeal Collateral Ligament Sprain
Caused by sudden impact (e.g., ball hitting fingertip)
Treatment: X-ray, splinting, buddy taping
Dislocated Fingers
Common in sports; caused by direct blows
Symptoms: deformity, pain
Treatment: splint, ice, physician reduction, 3 weeks immobilization
Hand & Wrist Muscle and Tendon Injuries
Tendonitis
Caused by overuse/stretch/impact
Symptoms: swelling, tenderness, reduced wrist flexion
Treatment: PRICE, heat, strengthening exercises
Mallet Finger
Extensor tendon injury from fingertip impact
DIP joint stuck in flexion
Treatment: Splint in extension, physician evaluation
Jersey Finger
FDP tendon avulsion from distal phalanx
Can’t flex fingertip
Mechanism: gripping and opponent pulls away
Treatment: Splint, X-ray, possible surgery
Boutonniere Deformity
PIP joint capsule/tendon injury
Inability to extend PIP, can flex DIP
Treatment: splinting, physician referral, possible surgery
Wrist & Hand Bone Injuries / Fractures
Metacarpal / Boxer’s Fracture
Mechanism: punching or impact
Symptoms: pain, swelling, deformity
Treatment: Splint, ice, X-ray, cast or surgery
Scaphoid Fracture
Common carpal fracture
Symptoms: pain in anatomical snuffbox, swelling
Risk: avascular necrosis
Treatment: splint, cast (8 weeks), surgery if needed
Colles Fracture
Treatment: Ice, splint, sling, X-ray, cast/surgery
Cumulative Trauma Disorders (CTDs)
Carpal Tunnel Syndrome (CTS)
Definition: Median nerve compression in carpal tunnel
Etiology: Repetitive motion, pregnancy, RA, diabetes
Symptoms: Numbness (except little finger), weak grip, pain from hand to elbow
Diagnosis: MRI, USG, EMG, Phalen/Tinel test
Management
Surgical: Carpal tunnel release
Non-surgical: Splinting, steroid injection, ergonomic changes
Complications: Neuroma, stiffness, recurrence
Prognosis: Mild/moderate responds well to conservative therapy; some may need surgery
De Quervain’s Tenosynovitis
Definition: Inflammation of 1st dorsal compartment tendons (EPB & APL)
Etiology: Repetitive thumb/wrist motion, overuse
Diagnosis: Clinical exam
Complications: Radial nerve injury, recurrence
Prognosis: Often resolves non-surgically, but high recurrence
Symptoms:
Pain near radial styloid
Pain with resisted radial deviation
Positive Finkelstein & Eichhoff test
Treatment
Non-surgical: Splint, NSAIDs, steroid injection
Surgical: Release of compartment if symptoms persist >6 months
Trigger Finger (Stenosing Tenosynovitis)
Definition: Flexor tendon sheath inflammation (A1 pulley)
Etiology: Repetitive gripping, diabetes, RA, thyroid issues
Diagnosis: Clinical based on locking/clicking
Complications: Injection side effects, surgical risks
Prognosis: Good with steroids or surgery
Symptoms
Painful locking/catching during flexion-extension
Tenderness/nodule at base of finger
Fixed-flexion deformity (late)
Treatment
Non-surgical: Steroid injection, splinting
Surgical: A1 pulley release
Distal radius fracture (fall on outstretched hand)
Symptoms: pain, deformity, swelling