functional anatomy of the hand and wristforms.acsm.org/16tpc/pdfs/20 osbahr.pdffunctional anatomy of...
TRANSCRIPT
![Page 1: Functional Anatomy of the Hand and Wristforms.acsm.org/16tpc/PDFs/20 Osbahr.pdfFunctional Anatomy of the Hand and Wrist COMMON SPORTS INJURIES Daryl C. Osbahr, M.D. Chief of Sports](https://reader034.vdocuments.net/reader034/viewer/2022052310/5f0f03107e708231d4420cb1/html5/thumbnails/1.jpg)
Functional Anatomy of the
Hand and Wrist COMMON SPORTS INJURIES
Daryl C. Osbahr, M.D. Chief of Sports Medicine, Orlando Health
Chief Medical Officer, Orlando City Soccer Club
Orthopedic Institute
Thank you Dr. Kenneth Means!
![Page 5: Functional Anatomy of the Hand and Wristforms.acsm.org/16tpc/PDFs/20 Osbahr.pdfFunctional Anatomy of the Hand and Wrist COMMON SPORTS INJURIES Daryl C. Osbahr, M.D. Chief of Sports](https://reader034.vdocuments.net/reader034/viewer/2022052310/5f0f03107e708231d4420cb1/html5/thumbnails/5.jpg)
Hand & Wrist Anatomy: Vascular
![Page 6: Functional Anatomy of the Hand and Wristforms.acsm.org/16tpc/PDFs/20 Osbahr.pdfFunctional Anatomy of the Hand and Wrist COMMON SPORTS INJURIES Daryl C. Osbahr, M.D. Chief of Sports](https://reader034.vdocuments.net/reader034/viewer/2022052310/5f0f03107e708231d4420cb1/html5/thumbnails/6.jpg)
http://www.chosun.ac.kr/~jdakim/lecture/gradu/hand.htm
Wrist Radiographic Anatomy
![Page 7: Functional Anatomy of the Hand and Wristforms.acsm.org/16tpc/PDFs/20 Osbahr.pdfFunctional Anatomy of the Hand and Wrist COMMON SPORTS INJURIES Daryl C. Osbahr, M.D. Chief of Sports](https://reader034.vdocuments.net/reader034/viewer/2022052310/5f0f03107e708231d4420cb1/html5/thumbnails/7.jpg)
http://www.chosun.ac.kr/~jdakim/lecture/gradu/hand.htm
![Page 8: Functional Anatomy of the Hand and Wristforms.acsm.org/16tpc/PDFs/20 Osbahr.pdfFunctional Anatomy of the Hand and Wrist COMMON SPORTS INJURIES Daryl C. Osbahr, M.D. Chief of Sports](https://reader034.vdocuments.net/reader034/viewer/2022052310/5f0f03107e708231d4420cb1/html5/thumbnails/8.jpg)
Normal Radiographic Paramaters
• Things to check for on every X-ray:
• On the A/P:
• Gilula’s lines
• Scapholunate gap
Scaphoid appearance
![Page 9: Functional Anatomy of the Hand and Wristforms.acsm.org/16tpc/PDFs/20 Osbahr.pdfFunctional Anatomy of the Hand and Wrist COMMON SPORTS INJURIES Daryl C. Osbahr, M.D. Chief of Sports](https://reader034.vdocuments.net/reader034/viewer/2022052310/5f0f03107e708231d4420cb1/html5/thumbnails/9.jpg)
A good lateral x-ray should have palmar pisiform edge lying between palmar scaphoid and palmar capitate edges
Also, the metacarpals should be parallel to the forearm
![Page 10: Functional Anatomy of the Hand and Wristforms.acsm.org/16tpc/PDFs/20 Osbahr.pdfFunctional Anatomy of the Hand and Wrist COMMON SPORTS INJURIES Daryl C. Osbahr, M.D. Chief of Sports](https://reader034.vdocuments.net/reader034/viewer/2022052310/5f0f03107e708231d4420cb1/html5/thumbnails/10.jpg)
Normal Radiographic Paramaters
• Things to check for on
every X-ray:
• On the lateral:
• Scapholunate angle
• Nl 30-60 degrees (avg.
47 degrees)
• Capitolunate angle
• Nl 0 +/- 15 degrees
• Radiolunate angle
• Nl 0 +/- 15 degrees
![Page 11: Functional Anatomy of the Hand and Wristforms.acsm.org/16tpc/PDFs/20 Osbahr.pdfFunctional Anatomy of the Hand and Wrist COMMON SPORTS INJURIES Daryl C. Osbahr, M.D. Chief of Sports](https://reader034.vdocuments.net/reader034/viewer/2022052310/5f0f03107e708231d4420cb1/html5/thumbnails/11.jpg)
![Page 12: Functional Anatomy of the Hand and Wristforms.acsm.org/16tpc/PDFs/20 Osbahr.pdfFunctional Anatomy of the Hand and Wrist COMMON SPORTS INJURIES Daryl C. Osbahr, M.D. Chief of Sports](https://reader034.vdocuments.net/reader034/viewer/2022052310/5f0f03107e708231d4420cb1/html5/thumbnails/12.jpg)
Hand & Wrist Sports Injuries
• Hand
• Baseball “Mallet” Finger
• Jersey Finger
• Gamekeeper’s / Skier’s Thumb (UCL)
• Bennett’s Fracture
• Metacarpal Neck Fractures (Boxer’s)
• Metacarpal Shaft Fractures
• Trigger Finger
![Page 13: Functional Anatomy of the Hand and Wristforms.acsm.org/16tpc/PDFs/20 Osbahr.pdfFunctional Anatomy of the Hand and Wrist COMMON SPORTS INJURIES Daryl C. Osbahr, M.D. Chief of Sports](https://reader034.vdocuments.net/reader034/viewer/2022052310/5f0f03107e708231d4420cb1/html5/thumbnails/13.jpg)
Hand & Wrist Sports Injuries
• Wrist
• Scaphoid Fracture
• Hamate Hook Fracture
• Distal Radius Fracture
• Wrist “Dislocation”
• Hypothenar Hammer Syndrome
• ECU Subluxation
• TFCC Injury
![Page 14: Functional Anatomy of the Hand and Wristforms.acsm.org/16tpc/PDFs/20 Osbahr.pdfFunctional Anatomy of the Hand and Wrist COMMON SPORTS INJURIES Daryl C. Osbahr, M.D. Chief of Sports](https://reader034.vdocuments.net/reader034/viewer/2022052310/5f0f03107e708231d4420cb1/html5/thumbnails/14.jpg)
Hand & Wrist Sports Injuries
• Hand
• Baseball “Mallet” Finger
• Jersey Finger
• Gamekeeper’s / Skier’s Thumb (UCL)
• Bennett’s Fracture
• Metacarpal Neck Fractures (Boxer’s)
• Metacarpal Shaft Fractures
• Trigger Finger
![Page 15: Functional Anatomy of the Hand and Wristforms.acsm.org/16tpc/PDFs/20 Osbahr.pdfFunctional Anatomy of the Hand and Wrist COMMON SPORTS INJURIES Daryl C. Osbahr, M.D. Chief of Sports](https://reader034.vdocuments.net/reader034/viewer/2022052310/5f0f03107e708231d4420cb1/html5/thumbnails/15.jpg)
Baseball “Mallet” Finger
• Appearance: Flexed DIP joint with
inability to extend.
• Cause: Loss of integrity in the extensor
mechanism at the base of the distal
phalanx
![Page 16: Functional Anatomy of the Hand and Wristforms.acsm.org/16tpc/PDFs/20 Osbahr.pdfFunctional Anatomy of the Hand and Wrist COMMON SPORTS INJURIES Daryl C. Osbahr, M.D. Chief of Sports](https://reader034.vdocuments.net/reader034/viewer/2022052310/5f0f03107e708231d4420cb1/html5/thumbnails/16.jpg)
Baseball “Mallet” Finger
• Pathology
• Laceration / Avulsion of
distal extensor tendon
• Fracture involving
extensor tendon insertion
• Treatment
• Closed injuries: DIP Extension
Splinting unless a Large
Fracture w/ joint subluxation
• Open injuries: Repaired
![Page 17: Functional Anatomy of the Hand and Wristforms.acsm.org/16tpc/PDFs/20 Osbahr.pdfFunctional Anatomy of the Hand and Wrist COMMON SPORTS INJURIES Daryl C. Osbahr, M.D. Chief of Sports](https://reader034.vdocuments.net/reader034/viewer/2022052310/5f0f03107e708231d4420cb1/html5/thumbnails/17.jpg)
Hand & Wrist Sports Injuries
• Hand
• Baseball “Mallet” Finger
• Jersey Finger
• Gamekeeper’s / Skier’s Thumb (UCL)
• Bennett’s Fracture
• Metacarpal Neck Fractures (Boxer’s)
• Metacarpal Shaft Fractures
• Trigger Finger
![Page 18: Functional Anatomy of the Hand and Wristforms.acsm.org/16tpc/PDFs/20 Osbahr.pdfFunctional Anatomy of the Hand and Wrist COMMON SPORTS INJURIES Daryl C. Osbahr, M.D. Chief of Sports](https://reader034.vdocuments.net/reader034/viewer/2022052310/5f0f03107e708231d4420cb1/html5/thumbnails/18.jpg)
Jersey Finger
• Not Named After New Jersey…
• Mechanism of Injury
• Cause: Loss of flexor mechanism
integrity at the distal phalanx
![Page 19: Functional Anatomy of the Hand and Wristforms.acsm.org/16tpc/PDFs/20 Osbahr.pdfFunctional Anatomy of the Hand and Wrist COMMON SPORTS INJURIES Daryl C. Osbahr, M.D. Chief of Sports](https://reader034.vdocuments.net/reader034/viewer/2022052310/5f0f03107e708231d4420cb1/html5/thumbnails/19.jpg)
Jersey Finger
• Pathology
• Tendon tear or avulsion fracture
involving insertion at distal phalanx
• Treatment: Repair
![Page 20: Functional Anatomy of the Hand and Wristforms.acsm.org/16tpc/PDFs/20 Osbahr.pdfFunctional Anatomy of the Hand and Wrist COMMON SPORTS INJURIES Daryl C. Osbahr, M.D. Chief of Sports](https://reader034.vdocuments.net/reader034/viewer/2022052310/5f0f03107e708231d4420cb1/html5/thumbnails/20.jpg)
Hand & Wrist Sports Injuries
• Hand
• Baseball “Mallet” Finger
• Jersey Finger
• Gamekeeper’s / Skier’s Thumb (UCL)
• Bennett’s Fracture
• Metacarpal Neck Fractures (Boxer’s)
• Metacarpal Shaft Fractures
• Trigger Finger
![Page 21: Functional Anatomy of the Hand and Wristforms.acsm.org/16tpc/PDFs/20 Osbahr.pdfFunctional Anatomy of the Hand and Wrist COMMON SPORTS INJURIES Daryl C. Osbahr, M.D. Chief of Sports](https://reader034.vdocuments.net/reader034/viewer/2022052310/5f0f03107e708231d4420cb1/html5/thumbnails/21.jpg)
Gamekeeper’s / Skier’s Thumb
• Pathology: Thumb UCL Injury
• Acute Injury
• Skiing
• Fall on outstretched thumb
• Struck by ball / opponent
• Chronic Injury
• Football linemen
• Gamekeepers
![Page 22: Functional Anatomy of the Hand and Wristforms.acsm.org/16tpc/PDFs/20 Osbahr.pdfFunctional Anatomy of the Hand and Wrist COMMON SPORTS INJURIES Daryl C. Osbahr, M.D. Chief of Sports](https://reader034.vdocuments.net/reader034/viewer/2022052310/5f0f03107e708231d4420cb1/html5/thumbnails/22.jpg)
Gamekeeper’s / Skier’s Thumb
• Treatment
• Partial Tear: Non-op
w/ Thumb Spica
Splint then PT
• Complete Tear:
Surgical Repair in
less than 3 wks
![Page 23: Functional Anatomy of the Hand and Wristforms.acsm.org/16tpc/PDFs/20 Osbahr.pdfFunctional Anatomy of the Hand and Wrist COMMON SPORTS INJURIES Daryl C. Osbahr, M.D. Chief of Sports](https://reader034.vdocuments.net/reader034/viewer/2022052310/5f0f03107e708231d4420cb1/html5/thumbnails/23.jpg)
Hand & Wrist Sports Injuries
• Hand
• Baseball “Mallet” Finger
• Jersey Finger
• Gamekeeper’s / Skier’s Thumb (UCL)
• Bennett’s Fracture
• Metacarpal Neck Fractures (Boxer’s)
• Metacarpal Shaft Fractures
• Trigger Finger
![Page 24: Functional Anatomy of the Hand and Wristforms.acsm.org/16tpc/PDFs/20 Osbahr.pdfFunctional Anatomy of the Hand and Wrist COMMON SPORTS INJURIES Daryl C. Osbahr, M.D. Chief of Sports](https://reader034.vdocuments.net/reader034/viewer/2022052310/5f0f03107e708231d4420cb1/html5/thumbnails/24.jpg)
Bennett’s Fracture
• 23 y.o. M baseball player
• Injured right thumb diving for a ball
• Pain, tenderness, and swelling at base
of the metacarpal
• No gross deformity
![Page 25: Functional Anatomy of the Hand and Wristforms.acsm.org/16tpc/PDFs/20 Osbahr.pdfFunctional Anatomy of the Hand and Wrist COMMON SPORTS INJURIES Daryl C. Osbahr, M.D. Chief of Sports](https://reader034.vdocuments.net/reader034/viewer/2022052310/5f0f03107e708231d4420cb1/html5/thumbnails/25.jpg)
![Page 26: Functional Anatomy of the Hand and Wristforms.acsm.org/16tpc/PDFs/20 Osbahr.pdfFunctional Anatomy of the Hand and Wrist COMMON SPORTS INJURIES Daryl C. Osbahr, M.D. Chief of Sports](https://reader034.vdocuments.net/reader034/viewer/2022052310/5f0f03107e708231d4420cb1/html5/thumbnails/26.jpg)
Bennett’s Fracture
• Fracture Pattern
• Oblique fracture line with a triangular
fragment at ulnar base of metacarpal
• Triangular fragment remains attached to
trapezium w/ proximal displacement of
the metacarpal
• Associated w/ metacarpal
subluxation/dislocation
• Opposing Forces
• Metacarpal shaft is displaced dorsally &
radial direction due to force of abductor
pollicis longus and adductor pollicis
• Treatment
• Surgery with CRPP vs. ORIF
![Page 27: Functional Anatomy of the Hand and Wristforms.acsm.org/16tpc/PDFs/20 Osbahr.pdfFunctional Anatomy of the Hand and Wrist COMMON SPORTS INJURIES Daryl C. Osbahr, M.D. Chief of Sports](https://reader034.vdocuments.net/reader034/viewer/2022052310/5f0f03107e708231d4420cb1/html5/thumbnails/27.jpg)
![Page 28: Functional Anatomy of the Hand and Wristforms.acsm.org/16tpc/PDFs/20 Osbahr.pdfFunctional Anatomy of the Hand and Wrist COMMON SPORTS INJURIES Daryl C. Osbahr, M.D. Chief of Sports](https://reader034.vdocuments.net/reader034/viewer/2022052310/5f0f03107e708231d4420cb1/html5/thumbnails/28.jpg)
Hand & Wrist Sports Injuries
• Hand
• Baseball “Mallet” Finger
• Jersey Finger
• Gamekeeper’s / Skier’s Thumb (UCL)
• Bennett’s Fracture
• Metacarpal Neck Fractures (Boxer’s)
• Metacarpal Shaft Fractures
• Trigger Finger
![Page 29: Functional Anatomy of the Hand and Wristforms.acsm.org/16tpc/PDFs/20 Osbahr.pdfFunctional Anatomy of the Hand and Wrist COMMON SPORTS INJURIES Daryl C. Osbahr, M.D. Chief of Sports](https://reader034.vdocuments.net/reader034/viewer/2022052310/5f0f03107e708231d4420cb1/html5/thumbnails/29.jpg)
Metacarpal Neck Fracture
• Appearance: Intrinsics flex MC head
• Finger Specific Evaluation
• Ring & Small (Boxer’s) Fingers
• Studies suggest up to 70°flexion tolerated
• Index & Middle Fingers
• No more than 15-20°flexion ok
• Treatment
• Cast if no malrotation or pseudoclawing
• If Surgery, CRPP or “bouquet pinning” if border digit (IF/SF)
![Page 30: Functional Anatomy of the Hand and Wristforms.acsm.org/16tpc/PDFs/20 Osbahr.pdfFunctional Anatomy of the Hand and Wrist COMMON SPORTS INJURIES Daryl C. Osbahr, M.D. Chief of Sports](https://reader034.vdocuments.net/reader034/viewer/2022052310/5f0f03107e708231d4420cb1/html5/thumbnails/30.jpg)
Metacarpal Neck Fracture
• 26 y.o. M professional baseball pitcher involved
in altercation with a wall
• Right index finger pain, tenderness, swelling,
and rotation deformity
![Page 31: Functional Anatomy of the Hand and Wristforms.acsm.org/16tpc/PDFs/20 Osbahr.pdfFunctional Anatomy of the Hand and Wrist COMMON SPORTS INJURIES Daryl C. Osbahr, M.D. Chief of Sports](https://reader034.vdocuments.net/reader034/viewer/2022052310/5f0f03107e708231d4420cb1/html5/thumbnails/31.jpg)
Reduction Maneuvers
Metacarpal Neck Fracture
CRPP: Bouquet Pinning
![Page 32: Functional Anatomy of the Hand and Wristforms.acsm.org/16tpc/PDFs/20 Osbahr.pdfFunctional Anatomy of the Hand and Wrist COMMON SPORTS INJURIES Daryl C. Osbahr, M.D. Chief of Sports](https://reader034.vdocuments.net/reader034/viewer/2022052310/5f0f03107e708231d4420cb1/html5/thumbnails/32.jpg)
Hand & Wrist Sports Injuries
• Hand
• Baseball “Mallet” Finger
• Jersey Finger
• Gamekeeper’s / Skier’s Thumb (UCL)
• Bennett’s Fracture
• Metacarpal Neck Fractures (Boxer’s)
• Metacarpal Shaft Fractures
• Trigger Finger
![Page 33: Functional Anatomy of the Hand and Wristforms.acsm.org/16tpc/PDFs/20 Osbahr.pdfFunctional Anatomy of the Hand and Wrist COMMON SPORTS INJURIES Daryl C. Osbahr, M.D. Chief of Sports](https://reader034.vdocuments.net/reader034/viewer/2022052310/5f0f03107e708231d4420cb1/html5/thumbnails/33.jpg)
Metacarpal Shaft Fracture
• Non-operative w/ Cast, if possible
• Operative Indications:
• Open fractures
• Multiple fractures
• Any malrotation
• Unstable fx’s – border metacarpals
more often unstable
• Multiple operative options: K-wires, IO
wires, IM pins/rods, lag screws,
plate/screws, transverse pinning
![Page 34: Functional Anatomy of the Hand and Wristforms.acsm.org/16tpc/PDFs/20 Osbahr.pdfFunctional Anatomy of the Hand and Wrist COMMON SPORTS INJURIES Daryl C. Osbahr, M.D. Chief of Sports](https://reader034.vdocuments.net/reader034/viewer/2022052310/5f0f03107e708231d4420cb1/html5/thumbnails/34.jpg)
![Page 35: Functional Anatomy of the Hand and Wristforms.acsm.org/16tpc/PDFs/20 Osbahr.pdfFunctional Anatomy of the Hand and Wrist COMMON SPORTS INJURIES Daryl C. Osbahr, M.D. Chief of Sports](https://reader034.vdocuments.net/reader034/viewer/2022052310/5f0f03107e708231d4420cb1/html5/thumbnails/35.jpg)
Hand & Wrist Sports Injuries
• Hand
• Baseball “Mallet” Finger
• Jersey Finger
• Gamekeeper’s / Skier’s Thumb (UCL)
• Bennett’s Fracture
• Metacarpal Neck Fractures (Boxer’s)
• Metacarpal Shaft Fractures
• Trigger Finger
![Page 36: Functional Anatomy of the Hand and Wristforms.acsm.org/16tpc/PDFs/20 Osbahr.pdfFunctional Anatomy of the Hand and Wrist COMMON SPORTS INJURIES Daryl C. Osbahr, M.D. Chief of Sports](https://reader034.vdocuments.net/reader034/viewer/2022052310/5f0f03107e708231d4420cb1/html5/thumbnails/36.jpg)
Trigger Finger
• i.e., Stenosing Tenosynovitis
• Fishing Analogy
• Like Having a Knot in Your
fishing line
• Knot gets caught in fishing
rod hooks
![Page 37: Functional Anatomy of the Hand and Wristforms.acsm.org/16tpc/PDFs/20 Osbahr.pdfFunctional Anatomy of the Hand and Wrist COMMON SPORTS INJURIES Daryl C. Osbahr, M.D. Chief of Sports](https://reader034.vdocuments.net/reader034/viewer/2022052310/5f0f03107e708231d4420cb1/html5/thumbnails/37.jpg)
Trigger Finger
• Risk factors for developing a trigger digit:
• Repetitive power grip, e.g. golf, baseball, tennis
• DM, RA, other inflammatory arthropathy, tendonopathy, etc.
• Treatment options
• Splint PIPJ in extension
• Corticosteroid injection – will typically try a total of 2; does not need to be injected into the sheath/tendon
• Surgical release
![Page 38: Functional Anatomy of the Hand and Wristforms.acsm.org/16tpc/PDFs/20 Osbahr.pdfFunctional Anatomy of the Hand and Wrist COMMON SPORTS INJURIES Daryl C. Osbahr, M.D. Chief of Sports](https://reader034.vdocuments.net/reader034/viewer/2022052310/5f0f03107e708231d4420cb1/html5/thumbnails/38.jpg)
Trigger Finger
Surgical Treatment: Release A1 Pulley
![Page 39: Functional Anatomy of the Hand and Wristforms.acsm.org/16tpc/PDFs/20 Osbahr.pdfFunctional Anatomy of the Hand and Wrist COMMON SPORTS INJURIES Daryl C. Osbahr, M.D. Chief of Sports](https://reader034.vdocuments.net/reader034/viewer/2022052310/5f0f03107e708231d4420cb1/html5/thumbnails/39.jpg)
Hand & Wrist Sports Injuries
• Wrist
• Scaphoid Fracture
• Hamate Hook Fracture
• Distal Radius Fracture
• Wrist “Dislocation”
• Hypothenar Hammer Syndrome
• ECU Subluxation
• TFCC Injury
![Page 40: Functional Anatomy of the Hand and Wristforms.acsm.org/16tpc/PDFs/20 Osbahr.pdfFunctional Anatomy of the Hand and Wrist COMMON SPORTS INJURIES Daryl C. Osbahr, M.D. Chief of Sports](https://reader034.vdocuments.net/reader034/viewer/2022052310/5f0f03107e708231d4420cb1/html5/thumbnails/40.jpg)
Hand & Wrist Sports Injuries
• Wrist
• Scaphoid Fracture
• Hamate Hook Fracture
• Distal Radius Fracture
• Wrist “Dislocation”
• Hypothenar Hammer Syndrome
• ECU Subluxation
• TFCC Injury
![Page 41: Functional Anatomy of the Hand and Wristforms.acsm.org/16tpc/PDFs/20 Osbahr.pdfFunctional Anatomy of the Hand and Wrist COMMON SPORTS INJURIES Daryl C. Osbahr, M.D. Chief of Sports](https://reader034.vdocuments.net/reader034/viewer/2022052310/5f0f03107e708231d4420cb1/html5/thumbnails/41.jpg)
Scaphoid Fracture
• Most common carpal
bone fracture
• sometimes initial XR’s
negative for 1-2 weeks
• Avascular Necrosis &
Nonunion are concerns
especially for waist or
proximal pole fractures
![Page 42: Functional Anatomy of the Hand and Wristforms.acsm.org/16tpc/PDFs/20 Osbahr.pdfFunctional Anatomy of the Hand and Wrist COMMON SPORTS INJURIES Daryl C. Osbahr, M.D. Chief of Sports](https://reader034.vdocuments.net/reader034/viewer/2022052310/5f0f03107e708231d4420cb1/html5/thumbnails/42.jpg)
Scaphoid Fracture
• Typically from a fall onto an
outstretched hand (FOOSH)
• Young patient (as opposed to
most distal radius fractures)
• May initially seem relatively
benign
• Delayed presentation not
uncommon because patient
not seeking treatment or
missed at initial presentation
![Page 43: Functional Anatomy of the Hand and Wristforms.acsm.org/16tpc/PDFs/20 Osbahr.pdfFunctional Anatomy of the Hand and Wrist COMMON SPORTS INJURIES Daryl C. Osbahr, M.D. Chief of Sports](https://reader034.vdocuments.net/reader034/viewer/2022052310/5f0f03107e708231d4420cb1/html5/thumbnails/43.jpg)
Scaphoid Fracture
• What is not controversial?
• Surgery for Displaced &
Unstable fractures
• What is controversial?
• How to reduce/stabilize?
• Open / CRPP / Scope
• How to treat Nondisplaced
fractures?
• Immobilization vs.
operative fixation
![Page 44: Functional Anatomy of the Hand and Wristforms.acsm.org/16tpc/PDFs/20 Osbahr.pdfFunctional Anatomy of the Hand and Wrist COMMON SPORTS INJURIES Daryl C. Osbahr, M.D. Chief of Sports](https://reader034.vdocuments.net/reader034/viewer/2022052310/5f0f03107e708231d4420cb1/html5/thumbnails/44.jpg)
![Page 45: Functional Anatomy of the Hand and Wristforms.acsm.org/16tpc/PDFs/20 Osbahr.pdfFunctional Anatomy of the Hand and Wrist COMMON SPORTS INJURIES Daryl C. Osbahr, M.D. Chief of Sports](https://reader034.vdocuments.net/reader034/viewer/2022052310/5f0f03107e708231d4420cb1/html5/thumbnails/45.jpg)
![Page 46: Functional Anatomy of the Hand and Wristforms.acsm.org/16tpc/PDFs/20 Osbahr.pdfFunctional Anatomy of the Hand and Wrist COMMON SPORTS INJURIES Daryl C. Osbahr, M.D. Chief of Sports](https://reader034.vdocuments.net/reader034/viewer/2022052310/5f0f03107e708231d4420cb1/html5/thumbnails/46.jpg)
Hand & Wrist Sports Injuries
• Wrist
• Scaphoid Fracture
• Hamate Hook Fracture
• Distal Radius Fracture
• Wrist “Dislocation”
• Hypothenar Hammer Syndrome
• ECU Subluxation
• TFCC Injury
![Page 47: Functional Anatomy of the Hand and Wristforms.acsm.org/16tpc/PDFs/20 Osbahr.pdfFunctional Anatomy of the Hand and Wrist COMMON SPORTS INJURIES Daryl C. Osbahr, M.D. Chief of Sports](https://reader034.vdocuments.net/reader034/viewer/2022052310/5f0f03107e708231d4420cb1/html5/thumbnails/47.jpg)
Hamate Hook Fracture
• 24 yo 2nd baseman pro
baseball player
• 12 months of vague ulnar
sided hand/wrist pain and
sense of weakness
• No neurovascular
symptoms or signs
• Flexor tendons intact
![Page 48: Functional Anatomy of the Hand and Wristforms.acsm.org/16tpc/PDFs/20 Osbahr.pdfFunctional Anatomy of the Hand and Wrist COMMON SPORTS INJURIES Daryl C. Osbahr, M.D. Chief of Sports](https://reader034.vdocuments.net/reader034/viewer/2022052310/5f0f03107e708231d4420cb1/html5/thumbnails/48.jpg)
Hamate
hook fx-
nonunion
fragment
![Page 49: Functional Anatomy of the Hand and Wristforms.acsm.org/16tpc/PDFs/20 Osbahr.pdfFunctional Anatomy of the Hand and Wrist COMMON SPORTS INJURIES Daryl C. Osbahr, M.D. Chief of Sports](https://reader034.vdocuments.net/reader034/viewer/2022052310/5f0f03107e708231d4420cb1/html5/thumbnails/49.jpg)
Opposite
left side
intact
hamate
hook
![Page 50: Functional Anatomy of the Hand and Wristforms.acsm.org/16tpc/PDFs/20 Osbahr.pdfFunctional Anatomy of the Hand and Wrist COMMON SPORTS INJURIES Daryl C. Osbahr, M.D. Chief of Sports](https://reader034.vdocuments.net/reader034/viewer/2022052310/5f0f03107e708231d4420cb1/html5/thumbnails/50.jpg)
![Page 51: Functional Anatomy of the Hand and Wristforms.acsm.org/16tpc/PDFs/20 Osbahr.pdfFunctional Anatomy of the Hand and Wrist COMMON SPORTS INJURIES Daryl C. Osbahr, M.D. Chief of Sports](https://reader034.vdocuments.net/reader034/viewer/2022052310/5f0f03107e708231d4420cb1/html5/thumbnails/51.jpg)
Ulnar nerve
branch to SF
ulnar digital
nerve
Ulnar nerve
branch to RF-
SF common
digital nerve
Ulnar artery
![Page 52: Functional Anatomy of the Hand and Wristforms.acsm.org/16tpc/PDFs/20 Osbahr.pdfFunctional Anatomy of the Hand and Wrist COMMON SPORTS INJURIES Daryl C. Osbahr, M.D. Chief of Sports](https://reader034.vdocuments.net/reader034/viewer/2022052310/5f0f03107e708231d4420cb1/html5/thumbnails/52.jpg)
Deep ulnar motor
nerve branch
Hamate hook
removed through
this space
![Page 53: Functional Anatomy of the Hand and Wristforms.acsm.org/16tpc/PDFs/20 Osbahr.pdfFunctional Anatomy of the Hand and Wrist COMMON SPORTS INJURIES Daryl C. Osbahr, M.D. Chief of Sports](https://reader034.vdocuments.net/reader034/viewer/2022052310/5f0f03107e708231d4420cb1/html5/thumbnails/53.jpg)
Hamate
hook
nonunion
excised
![Page 54: Functional Anatomy of the Hand and Wristforms.acsm.org/16tpc/PDFs/20 Osbahr.pdfFunctional Anatomy of the Hand and Wrist COMMON SPORTS INJURIES Daryl C. Osbahr, M.D. Chief of Sports](https://reader034.vdocuments.net/reader034/viewer/2022052310/5f0f03107e708231d4420cb1/html5/thumbnails/54.jpg)
Base of
hamate now
smooth after
hook excision
![Page 55: Functional Anatomy of the Hand and Wristforms.acsm.org/16tpc/PDFs/20 Osbahr.pdfFunctional Anatomy of the Hand and Wrist COMMON SPORTS INJURIES Daryl C. Osbahr, M.D. Chief of Sports](https://reader034.vdocuments.net/reader034/viewer/2022052310/5f0f03107e708231d4420cb1/html5/thumbnails/55.jpg)
Hand & Wrist Sports Injuries
• Wrist
• Scaphoid Fracture
• Hamate Hook Fracture
• Distal Radius Fracture
• Wrist “Dislocation”
• Hypothenar Hammer Syndrome
• ECU Subluxation
• TFCC Injury
![Page 56: Functional Anatomy of the Hand and Wristforms.acsm.org/16tpc/PDFs/20 Osbahr.pdfFunctional Anatomy of the Hand and Wrist COMMON SPORTS INJURIES Daryl C. Osbahr, M.D. Chief of Sports](https://reader034.vdocuments.net/reader034/viewer/2022052310/5f0f03107e708231d4420cb1/html5/thumbnails/56.jpg)
• Colle’s- dorsal displacement
• Stable, extraarticular cast
(VT < -20° RL < 10mm)
• Unstable, intraarticular
(VT > -20° RL >10 mm)
CREF +/-ORIF +/- ICBG
Distal Radius Fractures
![Page 57: Functional Anatomy of the Hand and Wristforms.acsm.org/16tpc/PDFs/20 Osbahr.pdfFunctional Anatomy of the Hand and Wrist COMMON SPORTS INJURIES Daryl C. Osbahr, M.D. Chief of Sports](https://reader034.vdocuments.net/reader034/viewer/2022052310/5f0f03107e708231d4420cb1/html5/thumbnails/57.jpg)
• Smith’s: volar displacement
• Volar ORIF with 3.5mm
locking plate
• Chauffer’s: radial styloid
• AARIF
• Beware of Greater &
Lesser Arc injuries
Distal Radius Fractures
![Page 58: Functional Anatomy of the Hand and Wristforms.acsm.org/16tpc/PDFs/20 Osbahr.pdfFunctional Anatomy of the Hand and Wrist COMMON SPORTS INJURIES Daryl C. Osbahr, M.D. Chief of Sports](https://reader034.vdocuments.net/reader034/viewer/2022052310/5f0f03107e708231d4420cb1/html5/thumbnails/58.jpg)
Hand & Wrist Sports Injuries
• Wrist
• Scaphoid Fracture
• Hamate Hook Fracture
• Distal Radius Fracture
• Wrist “Dislocation”
• Hypothenar Hammer Syndrome
• ECU Subluxation
• TFCC Injury
![Page 59: Functional Anatomy of the Hand and Wristforms.acsm.org/16tpc/PDFs/20 Osbahr.pdfFunctional Anatomy of the Hand and Wrist COMMON SPORTS INJURIES Daryl C. Osbahr, M.D. Chief of Sports](https://reader034.vdocuments.net/reader034/viewer/2022052310/5f0f03107e708231d4420cb1/html5/thumbnails/59.jpg)
Wrist “Dislocation”
…just mindin’ my own business
![Page 60: Functional Anatomy of the Hand and Wristforms.acsm.org/16tpc/PDFs/20 Osbahr.pdfFunctional Anatomy of the Hand and Wrist COMMON SPORTS INJURIES Daryl C. Osbahr, M.D. Chief of Sports](https://reader034.vdocuments.net/reader034/viewer/2022052310/5f0f03107e708231d4420cb1/html5/thumbnails/60.jpg)
• 49 y.o. playing rugby
• Right wrist injury while at the bottom of
a pileup
• Presents to ED with pain, swelling, and
median nerve symptoms
Wrist “Dislocation”
![Page 61: Functional Anatomy of the Hand and Wristforms.acsm.org/16tpc/PDFs/20 Osbahr.pdfFunctional Anatomy of the Hand and Wrist COMMON SPORTS INJURIES Daryl C. Osbahr, M.D. Chief of Sports](https://reader034.vdocuments.net/reader034/viewer/2022052310/5f0f03107e708231d4420cb1/html5/thumbnails/61.jpg)
![Page 62: Functional Anatomy of the Hand and Wristforms.acsm.org/16tpc/PDFs/20 Osbahr.pdfFunctional Anatomy of the Hand and Wrist COMMON SPORTS INJURIES Daryl C. Osbahr, M.D. Chief of Sports](https://reader034.vdocuments.net/reader034/viewer/2022052310/5f0f03107e708231d4420cb1/html5/thumbnails/62.jpg)
![Page 63: Functional Anatomy of the Hand and Wristforms.acsm.org/16tpc/PDFs/20 Osbahr.pdfFunctional Anatomy of the Hand and Wrist COMMON SPORTS INJURIES Daryl C. Osbahr, M.D. Chief of Sports](https://reader034.vdocuments.net/reader034/viewer/2022052310/5f0f03107e708231d4420cb1/html5/thumbnails/63.jpg)
![Page 64: Functional Anatomy of the Hand and Wristforms.acsm.org/16tpc/PDFs/20 Osbahr.pdfFunctional Anatomy of the Hand and Wrist COMMON SPORTS INJURIES Daryl C. Osbahr, M.D. Chief of Sports](https://reader034.vdocuments.net/reader034/viewer/2022052310/5f0f03107e708231d4420cb1/html5/thumbnails/64.jpg)
Hand & Wrist Sports Injuries
• Wrist
• Scaphoid Fracture
• Hamate Hook Fracture
• Distal Radius Fracture
• Wrist “Dislocation”
• Hypothenar Hammer Syndrome
• ECU Subluxation
• TFCC Injury
![Page 65: Functional Anatomy of the Hand and Wristforms.acsm.org/16tpc/PDFs/20 Osbahr.pdfFunctional Anatomy of the Hand and Wrist COMMON SPORTS INJURIES Daryl C. Osbahr, M.D. Chief of Sports](https://reader034.vdocuments.net/reader034/viewer/2022052310/5f0f03107e708231d4420cb1/html5/thumbnails/65.jpg)
Hypothenar Hammer Syndrome
• 52 y.o. M baseball bullpen coach
• Several months of ulnar sided wrist
pain now with increasing pain in ring
and small fingers
• X-ray and MRI negative for hamate
hook fracture or nonunion
![Page 66: Functional Anatomy of the Hand and Wristforms.acsm.org/16tpc/PDFs/20 Osbahr.pdfFunctional Anatomy of the Hand and Wrist COMMON SPORTS INJURIES Daryl C. Osbahr, M.D. Chief of Sports](https://reader034.vdocuments.net/reader034/viewer/2022052310/5f0f03107e708231d4420cb1/html5/thumbnails/66.jpg)
![Page 67: Functional Anatomy of the Hand and Wristforms.acsm.org/16tpc/PDFs/20 Osbahr.pdfFunctional Anatomy of the Hand and Wrist COMMON SPORTS INJURIES Daryl C. Osbahr, M.D. Chief of Sports](https://reader034.vdocuments.net/reader034/viewer/2022052310/5f0f03107e708231d4420cb1/html5/thumbnails/67.jpg)
After 24
hours of
thrombolytics
![Page 68: Functional Anatomy of the Hand and Wristforms.acsm.org/16tpc/PDFs/20 Osbahr.pdfFunctional Anatomy of the Hand and Wrist COMMON SPORTS INJURIES Daryl C. Osbahr, M.D. Chief of Sports](https://reader034.vdocuments.net/reader034/viewer/2022052310/5f0f03107e708231d4420cb1/html5/thumbnails/68.jpg)
![Page 69: Functional Anatomy of the Hand and Wristforms.acsm.org/16tpc/PDFs/20 Osbahr.pdfFunctional Anatomy of the Hand and Wrist COMMON SPORTS INJURIES Daryl C. Osbahr, M.D. Chief of Sports](https://reader034.vdocuments.net/reader034/viewer/2022052310/5f0f03107e708231d4420cb1/html5/thumbnails/69.jpg)
Operative intervention
• Trifurcate vein graft from dorsal hand
![Page 70: Functional Anatomy of the Hand and Wristforms.acsm.org/16tpc/PDFs/20 Osbahr.pdfFunctional Anatomy of the Hand and Wrist COMMON SPORTS INJURIES Daryl C. Osbahr, M.D. Chief of Sports](https://reader034.vdocuments.net/reader034/viewer/2022052310/5f0f03107e708231d4420cb1/html5/thumbnails/70.jpg)
![Page 71: Functional Anatomy of the Hand and Wristforms.acsm.org/16tpc/PDFs/20 Osbahr.pdfFunctional Anatomy of the Hand and Wrist COMMON SPORTS INJURIES Daryl C. Osbahr, M.D. Chief of Sports](https://reader034.vdocuments.net/reader034/viewer/2022052310/5f0f03107e708231d4420cb1/html5/thumbnails/71.jpg)
![Page 72: Functional Anatomy of the Hand and Wristforms.acsm.org/16tpc/PDFs/20 Osbahr.pdfFunctional Anatomy of the Hand and Wrist COMMON SPORTS INJURIES Daryl C. Osbahr, M.D. Chief of Sports](https://reader034.vdocuments.net/reader034/viewer/2022052310/5f0f03107e708231d4420cb1/html5/thumbnails/72.jpg)
Hand & Wrist Sports Injuries
• Wrist
• Scaphoid Fracture
• Hamate Hook Fracture
• Distal Radius Fracture
• Wrist “Dislocation”
• Hypothenar Hammer Syndrome
• ECU Subluxation
• TFCC Injury
![Page 73: Functional Anatomy of the Hand and Wristforms.acsm.org/16tpc/PDFs/20 Osbahr.pdfFunctional Anatomy of the Hand and Wrist COMMON SPORTS INJURIES Daryl C. Osbahr, M.D. Chief of Sports](https://reader034.vdocuments.net/reader034/viewer/2022052310/5f0f03107e708231d4420cb1/html5/thumbnails/73.jpg)
ECU Subluxation
• 32 y.o. F professional golfer
• Several months of wrist pain
• Now with mechanical symptoms at the
ulnar dorsal side of the wrist
• Nonoperative options (splinting, activity
modification, NSAIDS, corticosteroid
injection) failed to relieve symptoms to
her satisfaction
![Page 74: Functional Anatomy of the Hand and Wristforms.acsm.org/16tpc/PDFs/20 Osbahr.pdfFunctional Anatomy of the Hand and Wrist COMMON SPORTS INJURIES Daryl C. Osbahr, M.D. Chief of Sports](https://reader034.vdocuments.net/reader034/viewer/2022052310/5f0f03107e708231d4420cb1/html5/thumbnails/74.jpg)
![Page 75: Functional Anatomy of the Hand and Wristforms.acsm.org/16tpc/PDFs/20 Osbahr.pdfFunctional Anatomy of the Hand and Wrist COMMON SPORTS INJURIES Daryl C. Osbahr, M.D. Chief of Sports](https://reader034.vdocuments.net/reader034/viewer/2022052310/5f0f03107e708231d4420cb1/html5/thumbnails/75.jpg)
![Page 76: Functional Anatomy of the Hand and Wristforms.acsm.org/16tpc/PDFs/20 Osbahr.pdfFunctional Anatomy of the Hand and Wrist COMMON SPORTS INJURIES Daryl C. Osbahr, M.D. Chief of Sports](https://reader034.vdocuments.net/reader034/viewer/2022052310/5f0f03107e708231d4420cb1/html5/thumbnails/76.jpg)
![Page 77: Functional Anatomy of the Hand and Wristforms.acsm.org/16tpc/PDFs/20 Osbahr.pdfFunctional Anatomy of the Hand and Wrist COMMON SPORTS INJURIES Daryl C. Osbahr, M.D. Chief of Sports](https://reader034.vdocuments.net/reader034/viewer/2022052310/5f0f03107e708231d4420cb1/html5/thumbnails/77.jpg)
![Page 78: Functional Anatomy of the Hand and Wristforms.acsm.org/16tpc/PDFs/20 Osbahr.pdfFunctional Anatomy of the Hand and Wrist COMMON SPORTS INJURIES Daryl C. Osbahr, M.D. Chief of Sports](https://reader034.vdocuments.net/reader034/viewer/2022052310/5f0f03107e708231d4420cb1/html5/thumbnails/78.jpg)
![Page 79: Functional Anatomy of the Hand and Wristforms.acsm.org/16tpc/PDFs/20 Osbahr.pdfFunctional Anatomy of the Hand and Wrist COMMON SPORTS INJURIES Daryl C. Osbahr, M.D. Chief of Sports](https://reader034.vdocuments.net/reader034/viewer/2022052310/5f0f03107e708231d4420cb1/html5/thumbnails/79.jpg)
Hand & Wrist Sports Injuries
• Wrist
• Scaphoid Fracture
• Hamate Hook Fracture
• Distal Radius Fracture
• Wrist “Dislocation”
• Hypothenar Hammer Syndrome
• ECU Subluxation
• TFCC Injury
![Page 80: Functional Anatomy of the Hand and Wristforms.acsm.org/16tpc/PDFs/20 Osbahr.pdfFunctional Anatomy of the Hand and Wrist COMMON SPORTS INJURIES Daryl C. Osbahr, M.D. Chief of Sports](https://reader034.vdocuments.net/reader034/viewer/2022052310/5f0f03107e708231d4420cb1/html5/thumbnails/80.jpg)
TFCC Injury
• 22 y.o. M baseball player Right ulnar
sided wrist pain for several months
when batting
![Page 81: Functional Anatomy of the Hand and Wristforms.acsm.org/16tpc/PDFs/20 Osbahr.pdfFunctional Anatomy of the Hand and Wrist COMMON SPORTS INJURIES Daryl C. Osbahr, M.D. Chief of Sports](https://reader034.vdocuments.net/reader034/viewer/2022052310/5f0f03107e708231d4420cb1/html5/thumbnails/81.jpg)
• Tenderness at palmar/ulnar wrist
• No instability of the distal radioulnar joint (DRUJ) with pronation/supination or stress maneuvers
• MRI shows central tear of the triangular fibrocartilage complex (TFCC)
• Activity modification, NSAIDS, splinting, corticosteroid injections trialed all with temporary relief
TFCC Injury
![Page 82: Functional Anatomy of the Hand and Wristforms.acsm.org/16tpc/PDFs/20 Osbahr.pdfFunctional Anatomy of the Hand and Wrist COMMON SPORTS INJURIES Daryl C. Osbahr, M.D. Chief of Sports](https://reader034.vdocuments.net/reader034/viewer/2022052310/5f0f03107e708231d4420cb1/html5/thumbnails/82.jpg)
TFCC Injury
![Page 83: Functional Anatomy of the Hand and Wristforms.acsm.org/16tpc/PDFs/20 Osbahr.pdfFunctional Anatomy of the Hand and Wrist COMMON SPORTS INJURIES Daryl C. Osbahr, M.D. Chief of Sports](https://reader034.vdocuments.net/reader034/viewer/2022052310/5f0f03107e708231d4420cb1/html5/thumbnails/83.jpg)
TFCC Tear
![Page 84: Functional Anatomy of the Hand and Wristforms.acsm.org/16tpc/PDFs/20 Osbahr.pdfFunctional Anatomy of the Hand and Wrist COMMON SPORTS INJURIES Daryl C. Osbahr, M.D. Chief of Sports](https://reader034.vdocuments.net/reader034/viewer/2022052310/5f0f03107e708231d4420cb1/html5/thumbnails/84.jpg)
More chronic TFCC tear at
peripheral margin of central disc
![Page 85: Functional Anatomy of the Hand and Wristforms.acsm.org/16tpc/PDFs/20 Osbahr.pdfFunctional Anatomy of the Hand and Wrist COMMON SPORTS INJURIES Daryl C. Osbahr, M.D. Chief of Sports](https://reader034.vdocuments.net/reader034/viewer/2022052310/5f0f03107e708231d4420cb1/html5/thumbnails/85.jpg)
More acute central TFCC tear with
unstable flap
![Page 86: Functional Anatomy of the Hand and Wristforms.acsm.org/16tpc/PDFs/20 Osbahr.pdfFunctional Anatomy of the Hand and Wrist COMMON SPORTS INJURIES Daryl C. Osbahr, M.D. Chief of Sports](https://reader034.vdocuments.net/reader034/viewer/2022052310/5f0f03107e708231d4420cb1/html5/thumbnails/86.jpg)
Debriding the more chronic tear
![Page 87: Functional Anatomy of the Hand and Wristforms.acsm.org/16tpc/PDFs/20 Osbahr.pdfFunctional Anatomy of the Hand and Wrist COMMON SPORTS INJURIES Daryl C. Osbahr, M.D. Chief of Sports](https://reader034.vdocuments.net/reader034/viewer/2022052310/5f0f03107e708231d4420cb1/html5/thumbnails/87.jpg)
Debriding the more acute tear
![Page 88: Functional Anatomy of the Hand and Wristforms.acsm.org/16tpc/PDFs/20 Osbahr.pdfFunctional Anatomy of the Hand and Wrist COMMON SPORTS INJURIES Daryl C. Osbahr, M.D. Chief of Sports](https://reader034.vdocuments.net/reader034/viewer/2022052310/5f0f03107e708231d4420cb1/html5/thumbnails/88.jpg)
Central TFCC after debridement to
stable rims (volar, radial, and
dorsal rims visible on this photo)
![Page 89: Functional Anatomy of the Hand and Wristforms.acsm.org/16tpc/PDFs/20 Osbahr.pdfFunctional Anatomy of the Hand and Wrist COMMON SPORTS INJURIES Daryl C. Osbahr, M.D. Chief of Sports](https://reader034.vdocuments.net/reader034/viewer/2022052310/5f0f03107e708231d4420cb1/html5/thumbnails/89.jpg)
![Page 90: Functional Anatomy of the Hand and Wristforms.acsm.org/16tpc/PDFs/20 Osbahr.pdfFunctional Anatomy of the Hand and Wrist COMMON SPORTS INJURIES Daryl C. Osbahr, M.D. Chief of Sports](https://reader034.vdocuments.net/reader034/viewer/2022052310/5f0f03107e708231d4420cb1/html5/thumbnails/90.jpg)
Hand & Wrist Sports Injuries
• Very Complex Anatomy & Pathology
• Be Afraid of What you Don’t Know…
• Critically evaluate X-rays & Consider
MRI when indicated
• Sport Associated Injury Recognition
![Page 91: Functional Anatomy of the Hand and Wristforms.acsm.org/16tpc/PDFs/20 Osbahr.pdfFunctional Anatomy of the Hand and Wrist COMMON SPORTS INJURIES Daryl C. Osbahr, M.D. Chief of Sports](https://reader034.vdocuments.net/reader034/viewer/2022052310/5f0f03107e708231d4420cb1/html5/thumbnails/91.jpg)
2016 ACSM Team Physician Course
Orthopedic Institute