Injuries of the Forearm, Wrist,

Hand and Finger

• Mallet Finger (baseball or basketball finger)

– Etiology

• Caused by a blow that contacts tip of finger avulsing

extensor tendon from insertion

– Signs and Symptoms

• Pain at DIP; X-ray shows avulsed bone on dorsal

proximal distal phalanx

• Unable to extend distal end of finger (carrying at 30

degree angle)

• Point tenderness at sight of injury

– Management

• RICE and splinting for 6-8 weeks

• Boutonniere Deformity

– Etiology

• Rupture of extensor tendon dorsal to the middle

phalanx

Forces DIP joint into extension and PIP into flexion

– Signs and Symptoms

• Severe pain, obvious deformity and inability to

extend DIP joint

• Swelling, point tenderness

– Management

• Cold application, followed by splinting

• Splinting must be continued for 5-8 weeks

• Athlete is encouraged to flex distal phalanx

• Jersey Finger

– Etiology

• Rupture of flexor digitorum profundus tendon

from insertion on distal phalanx

• Often occurs w/ ring finger when athlete tries to

grab a jersey

– Signs and Symptoms

• DIP can not be flexed, finger remains extended

• Pain and point tenderness over distal phalanx

– Management

• Must be surgically repaired

• Rehab requires 12 weeks and there is often poor

gliding of tendon, w/ possibility of rerupture

• PIP Dorsal Dislocation

– Etiology

• Hyperextension that disrupts volar plate at middle

phalanx

– Signs and Symptoms

• Pain and swelling over PIP

• Obvious deformity, disability and possible avulsion

– Management

• Treated w/ RICE, splinting and analgesics followed

by reduction

• After reduction, finger is splinted at 20-30 degrees

of flexion for 3 weeks -- followed by buddy taping

• PIP Palmar Dislocation

– Etiology

• Caused by twist while it is semiflexed

– Signs and Symptoms

• Pain and swelling over PIP; point tenderness over

dorsal side

• Finger displays angular or rotational deformity

– Management

• Treat w/ RICE, splinting and analgesics followed by

reduction

• Splint in full extension for 4-5 weeks after which it

is protected for 6-8 weeks during activity

• Trigger Finger or Thumb (inability to extend)

– Etiology

• Repeated motion of fingers may cause irritation, producing

tenosynovitis

• Inflammation of tendon sheath (extensor tendons of wrist,

fingers and thumb, abductor pollicis)

• Thickening occurs w/in the sheath and, forming a nodule that

does not slide easily

– Signs and Symptoms

• Resistance to re-extension, produces snapping that is palpable,

audible and painful

• Palpation produces pain and lump can be felt w/in tendon

sheath

– Management

• Same treatment as de Quervain’s disease -- if unsuccessful,

injection and splinting are last options

• Sprains, Dislocations and Fractures of Phalanges– Etiology

• Phalanges are prone to sprains caused by direct blows or twisting

• MOI is also similar to that which causes fractures and dislocations

– Signs and Symptoms• Recognition primarily occurs through history

• Sprain symptoms - pain, sever swelling and hemorrhaging

• Gamekeeper’s Thumb– Etiology

• Sprain of UCL of MCP joint of the thumb

• Mechanism is forceful abduction of proximal phalanx occasionally combined w/ hyperextension

• Gamekeeper’s Thumb– Etiology

• Sprain of UCL of MCP joint of the thumb

• Mechanism is forceful abduction of proximal phalanx occasionally combined w/ hyperextension

– Signs and Symptoms• Pain over UCL in addition to weak and painful

pinch

– Management• Immediate follow-up must occur

• If instability exists, athlete should be referred to orthopedist

• If stable, X-ray should be performed to rule out fracture

• Thumb splint should be applied for protection for 3 weeks or until pain free

• Splint should extend from wrist to end of thumb in neutral position

• Thumb spica should be used following splinting for support

• Sprains of Interphalangeal Joints of Fingers

– Etiology

• Can include collateral ligament, volar plate, extensor

slip tears

• Occurs w/ axial loading or valgus/varus stresses

– Signs and Symptoms

• Pain, swelling, point tenderness, instability

• Valgus and varus tests may be possible

– Management

• RICE, X-ray examination and possible splinting

• Splint at 30-40 degrees of flexion for 10 days

• If sprain is to the DIP, splinting for a few days in full

extension may assist healing process

• Taping can be used for support

Finger Sprains

Finger Sprains (Volar Plate Rupture)

• MCP Dislocation

– Etiology

• Caused by twisting or shearing force

– Signs and Symptoms

• Pain, swelling and stiffness at MCP joint

• Proximal phalanx is angulated at 60-90

degrees

– Management

• RICE, splinting following reduction

• Buddy taping and given early ROM

following splinting

• Metacarpal Fracture

– Etiology

• Direct axial force or compressive force

• Fractures of the 5th metacarpal are associated w/ boxing

or martial arts (boxer’s fracture)

– Signs and Symptoms

• Pain and swelling; possible angular or rotational

deformity

– Management

• RICE, analgesics are given followed by X-ray

examinations

• Deformity is reduced, followed by splinting - 4 weeks of

splinting after which ROM is carried out

BOXER’S Fracture

• Distal Phalangeal Fracture

– Etiology

• Crushing force

– Signs and Symptoms

• Complaint of pain and swelling

of distal phalanx

• Subungual hematoma is often

seen in this condition

– Management

• RICE and analgesics are given

• Protective splint is applied as a

means for pain relief

• Subungual hematoma is drained

• Middle Phalangeal Fracture

– Etiology

• Occurs from direct trauma or twist

– Signs and Symptoms

• Pain and swelling w/ tenderness

over middle phalanx

• Possible deformity; X-ray will

show bone displacement

– Management

• RICE and analgesics

• No deformity - buddy tape w/ thermoplastic

splint for activity

• Deformity - immobilization for 3-4 weeks and

a protective splint for an additional 9-10 weeks

during activity

• Proximal Phalangeal Fracture

– Etiology

• May be spiral or angular

– Signs and Symptoms

• Complaint of pain, swelling, deformity

• Inspection reveals varying degrees of

deformity

– Management

• RICE and analgesics are given as

needed

• Fracture stability is maintained by

immobilization of the wrist in slight

extension, MCP in 70 degrees of

flexion and buddy taping

• PIP Fractures and Dislocation

– Etiology

• Combination of fracture and dislocation is

an axial load on a partially flexed finger

– Signs and Symptoms

• Condition causes pain and swelling in the

region of the PIP joint

• Localized tenderness over the PIP

– Management

• RICE, analgesics, followed by reduction

of the fracture

• If there is a small fragment, buddy taping

is used

• Large fragments - splint at 30-60 degrees

of flexion

•THE END !!!!