Chapter 15 the wrist hand and fingers
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Chapter 15 – The Wrist, Hand, and Fingers. Pages 556 - 559. Hand Pathology. Most injuries have acute onset Hyperflexion/hyperextension of wrist Axial load of metacarpal bones Crushing forces. Scaphoid Fractures. Bony block for wrist extension Blood supply Receives from distal end

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Chapter 15 – The Wrist, Hand, and Fingers

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Chapter 15 the wrist hand and fingers

Chapter 15 – The Wrist, Hand, and Fingers

Pages 556 - 559


Hand pathology

Hand Pathology

  • Most injuries have acute onset

    • Hyperflexion/hyperextension of wrist

    • Axial load of metacarpal bones

    • Crushing forces


Scaphoid fractures

Scaphoid Fractures

  • Bony block for wrist extension

  • Blood supply

    • Receives from distal end

    • Fracture may compromise nutrition to proximal end

    • High incidence of nonunion or malunion fractures secondary to avascular necrosis

    • Figure 15-27, page 557


Scaphoid fractures1

Scaphoid Fractures

  • Preiser’s Disease

    • Osteoporosis of scaphoid due to fx or repeated trauma

  • Signs and Symptoms

    • Aching pain in anatomical snuffbox area

    • Grip strength decreased

  • Evaluative Findings

    • Table 15-9, page 558


Scaphoid fractures2

Scaphoid Fractures

  • Pain in anatomical snuffbox area after hyperextension mechanism should be treated as scaphoid fracture

  • Treatment

    • Immobilization of wrist and thumb

    • Referral to physician

    • Fx may not be visible on x-ray right away


Scaphoid fractures3

Scaphoid Fractures

  • Conservative Treatment

    • Short arm thumb spica cast

    • Long arm thumb spica cast

      • Eliminates pronation and supination

      • May decrease risk of non- and malunions

  • Surgical Treatment

    • Displaced fractures

    • Some may chose to immediately fixate fracture

  • After healing phase, ROM and strengthening


Perilunate and lunate dislocation

Perilunate and Lunate Dislocation

  • Series of events

    • As limits of wrist/hand extension are exceeded– scaphoid strikes radius

    • Rupturing of volar ligaments that connect scaphoid to lunate

    • As force continues, distal carpal row is stripped away from lunate

    • Lunate rests dorsally relative to other carpals

    • This is a Perilunate Dislocation


Perilunate and lunate dislocation1

Perilunate and Lunate Dislocation

  • Series of events cont.

    • Further extension leads to rupture of dorsal ligaments

    • This relocates the carpals and rotates the lunate

    • Lunate rests volarly relative to other carpals

    • This is a lunate dislocation

  • Either dislocation may spontaneously reduce


Perilunate and lunate dislocation2

Perilunate and Lunate Dislocation

  • Signs and Symptoms

    • Pain along radial side of palmar or dorsal aspect of wrist that limits ROM

    • Bulge may be visible on dorsal or palmar aspect proximal to third metacarpal

    • Paresthesia in middle finger

  • Fracture of scaphoid should be suspected


Perilunate and lunate dislocation3

Perilunate and Lunate Dislocation

  • Evaluative Findings

    • Table 15-10, page 558

  • Kienbock’s Disease

    • Osteochondritis or slow degeneration of lunate

    • Due to repetitive trauma that may compromise vascular supply

    • May result in loss of ulnar deviation, tenderness, pain, swelling, decreased grip strength

    • Characteristic – pain during passive extension of third finger


Perilunate and lunate dislocation4

Perilunate and Lunate Dislocation

  • Treatment

    • Closed reduction and immobilization in flexion for 6-8 weeks

    • Frequent follow-ups

    • Pinning may be needed if reduction is lost


Metacarpal fractures

Metacarpal Fractures

  • Common for athlete to hear the bone snapping as it fractures

    • Immediate pain

    • Gross deformity may be visible or obscured by swelling (Figure 15-28, page 559)

    • Palpation reveals tenderness, crepitus, false joint

  • Evaluative Findings

    • Table 15-11, page 560


Metacarpal fractures1

Metacarpal Fractures

  • Long bone compression test

    • Figure 15-29, page 559

  • Boxer’s fracture

    • Fifth metacarpal

    • Depressed 5th MCP joint


Metacarpal fractures2

Metacarpal Fractures

  • Treatment

    • If no rotation – casting

    • With rotation – open reduction with internal fixation

    • After healing phase – ROM and strengthening (approximately 8 weeks after fracture)


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