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Eval- Hand Injuries
Hand injuries I
38
Other
Undergraduate 2
12/12/2010

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Cards

Term
Felon
Definition
Infection or abscess at DIP joint, Secondary to contusions/lacerations, infection of fingertip pad.

S&S: red, swollen, tender, warm, DIP

Treatment: anti-bac. soap soaks, oral anti-biotics, refer to physcian
Term
Paronychia
Definition
Nail Infection. MOI: bacteria enters skin

S&S: swelling, redness, pus, pain

Treatment: anti-bac. soap soaks, oral antibiotics, pus pocket has formed, it may need to be drained
Term
Subungual Hematoma
Definition
Bleeding under nail. MOI: direct blow, slamming finger in door, dropping heavy objects on toe

S&S: pain due to pressure, lumina-nail will fall off

Treatment: Ice, Elevation, NAIDS, Soap Soaks
Term
Cyclist's Palsy
Definition
Ulnar never, common in cyclist's, pressure on nerve.

S&S: numbness, pins and needles, decrease in grip strength, pain

Treatment: wear padded gloves, wrist/forearm splints, distribute weight evenly
Term
Ulnar Tunnel Syndrome
Definition
Increased pressure on ulnar nerve, susceptible to pressure: little padding.

S&S: weakness, numbness/tingling in ring or little finger, difficult to hold objects or pinching fingers together

Treatment: padding over nerve, anit-inflammatory meds., temporary wrist splint
Term
Anterior Interosseus Nerve Syndrome
Definition
Compression or inflammation of anterior interosseus nerve in forearm

S&S: Forearm pain, trouble grasping objects, numbness should not occur, location predisposed it to compression

Treatment: PT and NSAIDS reduce swelling, increase muscle strength, surgery, improve motor strength

*Unable to flex their thumb/index finer at DIP joint*
Term
Radial Nerve Entrapment
Definition
Compression by extensor muscles of radial nerve running posteriorly.

S&S: similar to lateral epicondylitis, pain/numbness on posterior hand, increased with pronation.

Treatment: Steriod injections to decrease pain, nerve decompression surgery
Term
Trigger Finger
Definition
Stenosing Tenosynovitis- Inflammation of tendon sheath affects flexor tenon.

S&S: Resistance to re-extend, tenderness, lump at base of flexor tendon sheath

Treatment: Immbolization, Rest, Cryotherapy, NSAIDS, Ultrasound, Steroid Injections to decrease pain
Term
Pseudoboutonnierre Deformity
Definition
Similar to Swan Neck. Distal tear of Volar Plate from middle phalanx, avulsion of volar plate

S&S: Pain, swelling, tenderness, hyperextension

Treatment: RICE, analgestics, splinting 20-30 degrees of flexion
Term
Boutonnierre Deformity
Definition
Rupture of extensor tendon, dorsal.
*DIP extend, PIP flex*

S&S: pain, swelling, inability to extend DIP

Treatment: splint middle finger using oval-8 splint in extension.
Term
DeQuervain's Tenosynovitis
Definition
"Hoffman's Disease"- in thumb-tunnel contracted from inflammation of synovial lining. Tendons: extensor/abductor.

S&S: aching pain hand/forearm, positive Finkelstein's Test, PT, Weakness with thumb extension/abduction, painful snapping

Treatment: Immbolize, rest, cryotherapy, NSAIDS, Ultrasound, Ice massage
Term
Wrist Sprains
Definition
Most common injury at wrist, falling on hyperextended wrist, repeated= blood supply to carpals

S&S: Pain, swelling, difficulty moving wrist, tenderness, limited ROM

Treatment: X-ray, PRICEM, splinting, taping, hand-strengthening exercises
Term
Volar Plate Injury
Definition
MOI: hyperextension of PIP joint, seen in sports like basketball

S&S: swelling, loss of function, could be subluxation of joint, swan neck deformity, pain on palpation

Treatment: PRICEM, passive hyperextension test-->compare to non-injured PIP joint, Refer to orthopedist, X-ray for possible avulsion fracture.
Term
Interphalangeal Collateral Ligament Sprain
Definition
MOI: excessive valgus or varus stresses, could happen from "jamming fingers"

S&S: point tenderness over ligaments, swelling, inflammation, could be bruising, possible deformity

Treatment: PRICEM, perform valgus/varus stress tests. possible bracing/buddy tape, need referral
Term
Jersey Finger
Definition
Avulsion of flexor digitorum profundus tendon. Affects ring finger, inability to flex DIP joint.

MOI: Athlete grabs abother jersey, Finger forced into extension when finger is trying to flex. Acceleration increased- flexor being damaged.

S&S: Pain, minimal swelling, increased pain during flexion, unable to flex DIP joint.

Treatment: Surgical reattachment
Term
Bowler's Thumb
Definition
*Caused by injury to tendon or ulnar nerve*

MOI: Repeated friction or compression over nerve during bowling, ulnar nerve goes into hook of hamate and branches to that thumb area.

S&S: Tingling to tip of thumb, small tendor nodule, numbness, wasting of the skin

Treatment: rest, splint for protextion, prevent by widening the thumb, changing technique.
Term
Gamekeeper's Thumb
Definition
Insufficiency of UCL of the metacarpophalangeal joint (MCP) of the thumb. Common in skiers, FB players, and basketball players.

MOI: FOOSH or valgus force on the thumb. Limits the opposition of the thumb and decreases grip strength.

S&S: Pain along ulnar aspect of MCP joint, hinders ability to forefully pinch or grasp smaller objects, swelling, ecchymosis, PT over the UCL, Pain and strength deficit during opposition.

Treatment: Depends on severity, incomplete- thumb spica splint. complete-surgery within 3 weeks
Term
Mallet Finger
Definition
Avulsion or rupture of an extensor tendon; inablity to fully extend the distal phalynx.

MOI: DIP is forced into flexion. Common when the fingertip is struck with a ball.

S&S: pain at distal phalynx at 25-25 degrees of flexion, inablity to extend the distal phalynx actively, slightly swollen and red.

Treatment: Ice to reduce swelling, splint finger in extension,tendon can be stitched,

S&S:
Term
MCP Dislocations
Definition
MOI: Volar plate is avulsed from the head of the first metacarpal, most common in thumb, a shearing or twisting force causing excessive extension and abduction.

S&S: pain, swelling, stiffness at MCP, Proximal phalanx is dorsally angualted to 60-90 degrees, no AROM, deformity

Treatment:RICE, splinting, analgesics, refer to physician, reduce injury and buddy tape
Term
PIP Joint Dislocation
Definition
Two types: palmar and dorsal

MOI: twist of finger while its semi flexed

S&S: pain, swelling , tenderness over PIP joint mostly on dorsal side, angular or rotational deformity

Treatment: RICE, splinting, and analgesics, refer to physician, reduction, splinted in full extension
Term
PIP Dorsal Dislocation
Definition
High rates of occurrence

MOI: hyperextension that produces a disruption of the volar plate

S&S: pain and swelling over PIP joint, avulsion, deformity

Treatment: RICE, splinting, analgesics, refer to physician, splinted in flexion, buddy tape
Term
DIP Joint Dislocation
Definition
MOI: dorsal dislocation, occurs from a ball striking the tip of a finger

S&S: pain, tenderness, swelling over DIP joint, deformity

Treatment: RICE, swelling, splinting, analgesics, refer to physician, splinted in 20-30 degrees flexion
Term
Scaphoid Fractures
Definition
Most frequently fractured of the carpal bones

MOI: FOOSH-compresses the scaphoid bone between the radius and second row of carpal bones, mistaken for sprain

S&S: swelling, severe point tenderness in anatomic snuff box, pain exerted on long axis of thumb

Treatment: Ice, splint the area, refer for x-ray, cast for 6 weeks, strengthening exercises and protective taping.
Term
Hamate Fractures
Definition
MOI: FOOSH, more commonly occurs from contact while athlete holds a rackets, bat or stick, fracture of hamate or hook

S&S: wrist pain, weakness, point tenderness, pull of the muscular attachments cause nonunion

Treatment: Casting of wrist, hook of hamate can be protects by donut pad
Term
Triquetrum Fractures
Definition
MOI: FOOSH with forcible palmar flexion or violent extension, sudden resistance against twisting motions of the wrist

S&S: pain, swelling, tenderness, restricted movement

Treatment: RICE, wrist support, cast, physiotherapeutic measures
Term
Metacarpal Fractures
Definition
MOI: direct axial force or a compressive force

S&S: pain, swelling, may appear to be an angularor rotational deformity

Treatment: RICE, analgesics, X-ray, splinting
Term
Phalangeal Fractures
Definition
Distal: MOI- crushing force
Middle: MOI- direct trauma or twist
Proximal: MOI- spiral or angular
*Most common in the hand*

S&S: pain, swelling, point tenderness, deformity

Treatment: RICE, analgesics, splint
Term
Carpal Tunnel Syndrome
Definition
Compression of median nerve

S&S: pain, weakness, or numbness in the hand and wrist radiating up the arm, pain at night or in the morning, may feel the need to "shake out" their hand, decreased grip strength

Causes: Hypothyroidism, arthritis, diabetes, trauma, or repetitive movement such as typing.
Term
Forearm Splints
Definition
Tendons unable to stand the stress that is being placed. Tissues tear away from the bone or bones that they are attached to. Similar to shin spints

MOI: Overuse, gymnasts

S&S: Sharp pain in forearm (Increased with flexion/extension), decreased strength.

Treatment: Ice, elevation, compression, stop physical activities, strengthen muscles in the forearm
Term
Triangular Fibrocartilage Complex Injury
Definition
MOI: Direct blow to medial side of wrist, FOOSH, Positive ulnar variance- congenital

S&S: clicking or catching on the ulnar side of the wrist, pain along ulnar side of wrist, decreased wrist motion, possible swelling

Treatment: Splint or cast, ice, MRI, Anti-inflammatory med., rehab exercises, injection of cortisone
Term
Ganglion Cysts
Definition
Benign collection of thick fluid within tendonious sheath or joint capsule

MOI: overuse of repeated movements in the wrist, associated with rheumatoid arthritis

S&S: Pain with motion of wrist, tender to touch, may be asymptomatic

Treatment: Rest, splinting of affected joint, aspiration of the cyst
Term
Colles' Fracture
Definition
Most common forearm fracture, involves lower end of radius

MOI: FOOSH, forcing of the radius backward and upward (hyperextension), DORSALLY displaced

Smith (Palmar)

S&S:Profuse bleeding along with extravasated fluid cause swelling in the wrist, tendons may be torn or avulsed, possible median nerve damage

Treatment: apply cold compresses, splint wrist, limb in the sling, refer to physician for X-ray
Term
Boxer's Fracture
Definition
Fracture of the 5th metacarpal

MOI: compressive force, most commonly after an improperly thrown punch

S&S: Pain, point tenderness, swelling, deformity, depressed 5th MCP joint, crepitus from bony fragments, overlapping bone fragments on x-ray

Treatment: PRICEM, refer to physician, cast, open reduction with internal fixation to assit proper healing
Term
Barton's Fracture
Definition
An intraarticular fracture with dislocation of the radial carpal joint

MOI: falling on the back of the hand

Treatment: PRICEM, refer, x-ray, splint/cast

*in children and youth potential epiphyseal fracture
Term
Bennett's Fracture
Definition
MOI: fractures of the base of the 5th meracarpal that extend into the articular surface, fall on the thumb or direct blow to the thumb, common in football, rugby

S&S: Severe pain at the thumb, swelling at the thumb and wrist, instability of the thumb joint

Treatment: require internal fixation of the bony fracture
Term
Kienbocks Disease
Definition
MOI: Osteochondritis or slow degeneration of the lunate bone, repeated trauma to the lunate, loss of: ulnar deviation id goes untreated

S&S: pain during passive extension of the 3rd finger, decreased grip strength, weakness during wrist extension

Treatment: immbolization of wrist for 3 weeks, common to see progression for a year, referto surgeon
Term
Lunate Dislocation
Definition
MOI: high-energy forced hyperextension of the wrist and hand, FOOSH, weight lifting and football, displaces dorsally or palmarly

S&S: semi-flexed fingers, swelling, PT, crepitus, paresthesia of the middle finger, fracture of scaphoid bone

Treatment: Refer to othopedist, first 3 weeks= reduction
Term
Distal Radial Ulnar Dislocations
Definition
MOI: "Dislocated Wrist", indirect or direct trauma or forced hypersupination or hyperpronation of the forearm

S&S: Pain on rotation, loss of function, deformity, swelling, PT, increased prominence of the ulnar head, narrow wrist

Treatment: refer to orthopedist, X-ray for possible fracture
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