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HAND INJURY - Coggle Diagram

- - - - cause
        
        Fall on outstretched hand
      - mechanism
        
        Scaphoid compressed between radius & carpal bones
      - signs & symptoms
        
        Swelling near carpal bones
        
        Tenderness in anatomical snuffbox
        
        Pain with thumb pressure or radial flexion
        
        Often mistaken for wrist sprain
      - Complications
        
        Poor blood supply → Avascular necrosis
        
        May not heal even with splinting
        
        May require surgery
      - medical management
        
        ice & splint
        
        Refer for X-ray
        
        Casting for ~8 weeks
        
        Strengthening & taping after cast removal
    - - cause
        
        Fall or motor vehicle accident
      - mechanism
        
        Force pushes hand backward
      - medical management
        
        Ice, splint, sling
        
        Treat for shock
        
        Doctor will X-ray & apply cast
        
        Severe fracture → surgery (pins, screws, wires)
    - - mechanism
        
        striking an object
        
        having hand stepped on
      - signs & symptoms
        
        pain
        
        deformity
        
        swelling
        
        abnormal mobility
  - - - definition
        
        occur overuse, falls & forceful twisting motion
      - sign & symptoms
        
        pain & swelling
        
        decreased ROM
        
        decreased grip strength
      - management
        
        Restore ROM (Range of Motion) & Strength
        
        Use tape or brace during return to sport
        
        PRICE: Protect, Rest, Ice, Compression, Elevation
    - - Definition
        
        Skier’s thumb is an injury to the thumb’s medial collateral ligament, common in skiing accidents.
      - Etiology
        
        Forceful abduction of the thumb
        
        Trauma from catching a ball or falling
        
        Direct impact to the thumb tip
      - Management
        
        Splint medial side of thumb
        
        X-ray to check for avulsion fracture
        
        Surgery needed if avulsion is present
        
        Apply ice
    - - Etiology
        
        Hit by ball
        
        Finger caught in jersey
      - Anatomy & Function
        
        Located on the sides of each interphalangeal joint (finger joints).
        
        Provides stability when the fingers are stressed or pushed sideways.
      - management
        
        Splint when not active
        
        Buddy taping to adjacent finger when playing
        
        X-ray to rule out fracture
        
        Ice to reduce swelling
        
        Add padding if needed
    - - Definition
        
        Dislocation of the phalanges involves displacement of finger joints, common in sports
      - Etiology
        
        Caused by blow to fingertip.
      - Pathophysiology
        
        One bone moves dorsally, one anteriorly.
      - Management
        
        Must be reduced by physician.
        
        Apply ice for swelling & pain
        
        Splint the finger
        
        Refer to physician for reduction & X-ray
        
        Splint for ~3 weeks in 30° flexion
      - Complication
        
        Improper reduction → permanent damage
  - - - Definition
        
        inflammation of tendon
      - mechanism of injury
        
        stretching
        
        impact
        
        overuse
      - Signs & symptom
        
        generalized swelling
        
        tenderness
        
        inability to flex the wrist
    - - Symptom
        
        Fingertip stuck in flexion
      - Pathophysiology
        
        Torn extensor tendon
      - Etiology
        
        Impact to fingertip
      - medical management
        
        Apply ice
        
        Splint finger in extension
        
        Refer to physician
        
        Treatment: splinting or surgery
        
        Risk: permanent DIP flexion if untreated
    - - Injury
        
        FDP tendon avulsed from distal phalanx
      - Sign
        
        Can’t bend fingertip (DIP joint)
      - Cause
        
        Forceful extension during active flexion
      - medical management
        
        Apply splint and ice
        
        X-ray & doctor evaluation
        
        Physician decides: surgery or continued splinting
    - - Cause
        
        Hard hit to PIP → joint capsule tears
      - Injury
        
        Extensor tendons displace laterally
      - location
        
        PIP joint
      - sign
        
        Can flex DIP but can't extend PIP
      - medical management
        
        Splint the finger
        
        Refer to physician
        
        Often healed with splinting
        
        Surgery may be needed in some cases
- - - - Entrapment neuropathy
      - Compression of median nerve in carpal tunnel at wrist
    - - ↑ Pressure in carpal tunnel → venous congestion & local edema
      - ↓ Blood flow to median nerve → nerve dysfunction
      - Myelin & axon damage over time
      - Repetitive motion increases friction, strain & microtrauma
      - Leads to inflammation & soft tissue damage
    - - Genetic predisposition
      - Repetitive wrist motion (typing, machine work)
      - Obesity
      - Autoimmune disorders (e.g. RA)
      - Pregnancy
    - - Numbness/tingling (excluding little finger)
      - Weak thumb or poor grip
      - Pain in fingers or forearm (hand to elbow)
    - - Wrist splint (especially at night)
      - Reduce repetitive movements
      - Hand exercises & median nerve gliding
      - Ergonomic & postural training
      - Steroid injections
      - Alternative therapies: yoga, acupuncture
      - Surgical option: carpal tunnel release
    - - Due to CTS:
        
        Permanent median nerve damage
        
        Chronic wrist/hand pain
        
        Thenar muscle atrophy → weak grip & poor dexterity
      - Due to Surgery:
        
        Neuroma (palmar cutaneous branch)
        
        Hypertrophic scars
        
        Dysesthesia after repeated procedures
        
        Wrist stiffness
        
        Symptoms may persist
    - - Progressive; may cause permanent nerve damage
      - ⅓ recur after surgery (within 5 years)
      - 90% mild/moderate cases improve conservatively
      - Worse in diabetes or wrist fracture
      - Poor outcome if normal or severe nerve test results
  - - - tenosing inflammation of the 1st dorsal compartment of the wrist
      - Involves tenosynovitis (tendon sheath inflammation)
    - - repetitive wrist/thumb movements (e.g., lifting baby, texting, typing)
      - Tendon sheath thickens → tendons get trapped
    - - Pain on the thumb side of the wrist
      - Pain when gripping or lifting
      - Pain with thumb movement
      - Swelling near the wrist
    - - non surgical
        
        Rest
        
        Painkillers (NSAIDs)
        
        Thumb spica splint
        
        Steroid injection
      - surgical
        
        Release the tight tendon sheath
    - - Nerve injury (radial nerve)
      - Pain returns (recurrence)
      - Nerve trapped in separate tendon sheath
    - - Finkelstein Test:
        Make a fist with the thumb inside → bend wrist towards pinky → sharp pain = positive
    - - Most cases get better with nonsurgical treatment But there's a risk of recurrence
  - - - Swollen tendon in the finger
      - Common in ring finger and thumb
      - Caused by repetitive use
      - Finger may click, lock, or feel stuck
    - - diabetes
      - amyloidosis
      - thyroid disease
      - rheumatoid arthritis
      - cts
      - gout
    - - Microtrauma from repetitive use or pressure
      - Causes inflammation and injury in flexor tendon sheath
      - A1 pulley is most affected
      - Inflammation makes tendon stick in sheath → causes locking
      - Flexor tendon strong → bending finger is easy
      - Locking happens when trying to straighten (extend) finger
    - - Microtrauma from repetitive use or pressure
      - Causes inflammation and injury in flexor tendon sheath
      - A1 pulley is most affected
      - Inflammation makes tendon stick in sheath → causes locking
      - Flexor tendon strong → bending finger is easy
      - Locking happens when trying to straighten (extend) finger
    - - splinting
      - steroid injection
    - - tissues atrophy
      - skin discoloration
      - hypopigmention
      - even infection