UL: HANDS INJURIES Flashcards
HANDS
FLEXOR ZONES OF THE HAND
T1: Thumb
T2
T3
ZONE 1: from distal phalanges to the mid-shaft of medial phalanges
ZONE 2: from mid-shaft of medial phalange to V
ZONE 3:from V to mid TIV
HANDS
EXTENSOR ZONES
HANDS
INTRINSIC MUSCLES
HANDS
EXTRINSIC MUSCLES
NEUROVASCULAR INJURIES
Usually chronic nerve entrapment rather than an acute episode
Guyons: ulnar nerve entrapment in cyclists and wheelchair athletes, severe OA
Carpal tunnel is a common problem esp.. in wheelchair athletes, office workers, pregnancy
GUYONS CANAL
Entrapment of ulnar nerve at the wrist – d/t repeated blunt trauma / oedema
Settles with rest – splinting for approx 4 weeks. If not – surgery
Sport: cyclin
CARPAL TUNNEL
Entrapment of the Median nerve (most common)
↑ pressure beneath the transverse flexor carpal lig as a result of synovial thickening
Clinical: Phalens and reverse Phalens test
RX:HCI
Splinting 4 weeks @ night
PHYSIO
Exercise
Neural glides
If no response - surgery
COLLATERAL LIGAMENT INJURIES
MECHANISM: lateral force directed @ PIP (Forced ulnar or radial deviation)
Very common
Evaluate active + passive stability
Present with pain / oedema
Passive stability tested in 30˚ flexion while the MCP jt is flexed at 90˚; an extended MCP joint will tighten the collateral ligaments, inhibiting the evaluation.
All sports, MVA, falls, jammed in car door
Rx:
Gr 1 – buddy strapping + careful return to play/ activity
Gr 2 – buddy strapping for 6-8 wks. (no sport). Static extension splint (starting in slight flex)
Gr 3 – conservative / ORIF. Full ext. for 5-6 wks.
PHALANGEAL FRACTURES
NB – few deforming forces (only proximally), hypersensitive with injury, reeducation sensation/proprioception
RX:
3 weeks immobilisation
Shaft fractures of middle phalanx take longer to heal than proximal phalanx
Close proximity of flexor sheath to bone –ADHESIONS
THUMB PATHOMECHANICS
UCL Mechanism of injury: laterally directed force @ the PIP
Rugby, skiing, cycling, horse riding, fall on outstretched hand
Exam:
tenderness, pain ulna side MP
Tested in 30˚ flex (RCL tested in ext)
UCL Rx:
Complete tears require operative mx within 3 weeks + then splinting 6 wks.
Return to play @ 3 mths.
If conservative, then splint for 3-6 wks.
Late presentation →chronic instability, pain + pinch weakness
DE QUEURVAINS
Racquet sports, weight lifting, pregnancy
Repetitive wrist mvt with APL + EPB
EXTENSOR MECHANISM Triangular ligament Central Slip Oblique Retinacular Lateral Band Sagittal Band
EXTENSOR INJURIES
Mallet finger Swan neck Central slip disruptions Boutonniere Extensor mechanism in fractures
EXTENSOR INJURIES
MALLET FINGER
Mechanism of injury:
Forced flexion on an actively extended finger
Direct blow on the fingertip
Laceration
All ball sports, tucking in sheets/shirt
Three types (Doyle's Classification – 4): Partial interruption of extensor tendon Complete disruption of the extensor tendon Avulsion fracture
Mallet Finger Rx Conservative: 8 wks. in splint – 24/7 Then night splinting Can stop night splinting when pt. able to maintain full DIP extension @ end of the day
Surgery:
K-wire + 8 weeks in splint
Interruption of the terminal extensor tendon
All extensor force goes to the central slip + the lateral bands
All extensor force to PIP
Interruption of the terminal extensor tendon
All extensor force goes to the central slip + the lateral bands
All extensor force to PIP
EXTENSOR INJURIES
SWAN NECK DEFORMITY
Swan Neck Rx Conservative: If can be passively corrected. Gutter / Oval 8 Active ex
Surgery:
If cant passively correct.
Post op: gutter / night splinting only – need to Ax
Ex
BOUTONNIERE DEFORMITY
All extension force @ DIP
Lateral bands migrate volarly, + act as PIP flexors
PIP flexion as FDS unopposed
PIP initially passively correctable, then contracture develops
Tight ORL
Rx: Conservative: • If can passively correct • Oval 8 / serial casting / neoprene sleeves • Surgery: • If can’t passively correct • Diff – adhesions etc
