WristHand Sports med 2 Articulations Radiocarpal Flexion extension

Wrist/Hand Sports med 2

Articulations • Radiocarpal – Flexion, extension, abduction, and circumduction • Carpal – Gliding joints – Stabilized by anterior, posterior, and connecting ligaments • Metacarpal – Flexion, extension, abduction, adduction, circumduction • Phalangeal – Hinge joints – Proximal interphalangeal (PIP), Distal interphalangeal (DIP)

Ligaments • Wrist – Ulnar Collateral ligament • Ulna to pisiform – Radial collateral ligament • Radius to scaphoid – Transverse carpal ligament • Roof of the “carpal tunnel” • Phalanges – Collateral ligaments

Muscles • Flexors – Palmar surface – Flexor digitorum superficialis, flexor digitorum profundus • Extensors – Dorsal surface – Extensor digitorum longus, • Intrinsics – Abduction and adduction

Blood/Nerve Supply • Nerves – Ulnar, radial – Median • Enters palm through carpal tunnel • Arteries – Radial – ulnar

Assessment • History – MOI – Location and type of pain? – Increases or decreases pain? – History of trauma or overuse? – Any therapy given in the past?

Assessment • Observations – Hand usage like writing, unbuttoning shirt – Open and close hand • Fully? Rythmically? – Touch thumb to each fingertip – Flat knuckle – Color of fingernails • Pale= poor circulation

• Palpations Assessment – Bony • Scaphoid (anatomical snuffbox) • Lunate • Hamate (hook) • Metacarpals • Phalanges (proximal, middle, and distal) – Soft • Triangular fibrocartilage (TFCC) • Collateral ligaments of phalanges • Flexor and extensor muscles Use hand flashcards for palpation practice

MMTs • Flexion • Extension • Ulnar deviation – 5 th digit moves towards ulna • Radial Deviation – Thumb moves towards radius • Finger Abduction – Fingers spread out • Finger Adduction – Fingers back together Perform Active, passive, resistive of all movements on ALL fingers

Tenosynovitis • MOI – Repetitive use and overuse of tendons and their sheaths • S/S – Pn with use, pn w/passive stretching – Tenderness, swelling over tendon • TX – Ice massage, NSAIDS, rest – ROM, contrast baths, US, PRE

Carpal Tunnel Syndrome • MOI – Inflammation in the carpal tunnel, compresses median nerve – Repeated flexion, or direct blow • S/S – Tingling, numbness, weakness • TX – Rest, immobilization, NSAIDS – Possible surgery

Finkelsteins Test tests for http: //youtu. be/l. XV_UV 62 USc de Quervain’s disease • Procedure – Athlete is sitting, forms a fist around the thumb. – Examiner grasps the athlete's forearm and fist and ulnarly deviates • Positive Test – Pn. = Possible tenosynovitis (de Quervain’s disease) – Pn. At carpal tunnel = carpal tunnel syndrome

Phalens Test • Procedure http: //youtu. be/DZ 9 UGu. A 8 o. AE – Have athlete flex both wrists as far as possible and press together for 1 minute • Positive Test – Pn. At the carpal tunnel = carpal tunnel syndrome

Wrist Sprains (most common) • MOI – Falling on hyperextended wrist – Violent flexion or torsion • S/S – Pn, swelling, decreased AROM • TX – RICE, splinting, analgesics – Tape, strengthening

Gamekeepers Thumb • MOI (skiiers, tacklers) – Sprain of UCL ligament of MCP joint of thumb – Forceful abduction with hyperextension • S/S – Pn, weak pinch, – Tenderness and swelling • TX – Refer – Splint 3 weeks

Glide Test http: //youtu. be/Yr. J 98 IYsg. Bw • Procedure – Grasp the athletes wrist with one hand their carpals with the other – Move anterior/posterior and radial/ulnar directions – Can also do on each phalange/metacarpal joint • Positive Test – Pn. /laxity = sprain

Valgus/Varus • Procedure – Examiner maintains stabilization of the proximal bone between the thumb and forefinger and grasps the distal bone – Examiner provides a valgus/varus force • Positive Test – Pn. /laxity = collateral ligament tear/sprain

Triangular Fibrocartilage Complex Injury (TFCC) • MOI – Forced hyperextension • S/S – Pn along the ulnar side of wrist – Extension = pn, difficulty – Swelling later on • TX – refer

Scaphoid Fx (most common) • MOI – FOOSHA, compresses scaphoid between radius and carpals • S/S – Point tenderness in snuff box – Pn. With thumb compression and radial flexion • TX – Splint and refer for x-ray – Untreated leads to necrosis

Hamate (hook) Fx • MOI – Direct blow from racket, bat, sports stick, club • S/S – Wrist pn and weakness – Point tender • TX – Refer for x-ray – Doughnut pad

Colles Fx • MOI – Fx to distal end of radius or ulna – FOOSHA, or hyperextension • S/S – Visible deformity – Swelling and pn • TX – Ice and splint – refer

Boxers (5 th metacarpal) Fx • MOI – Direct axial force (punching) – Getting stepped on • S/S – Pn and swelling • TX – RICE, analgesics, refer – Splint 4 weeks, early ROM

Compression Test • Procedure – Athlete has finger extended – Examiner holds the distal phalanx and applies compression along the axis of the bone of the finger being tested – Can also be done on metacarpal in fist position • Positive Test – Pn at injury site = possible fx

Allens Test http: //youtu. be/jq 0 ai 5 u. Xx 68 • Procedure – Athlete squeezes hand into a fist and fully opens hand 3 -4 times – With athlete holding the last fist the evaluator puts pressure over radial and ulnar artery – Athlete opens hand (appears white), evaluator releases 1 artery and the hand should become red • Positive Test – Not turning red instantly = radial or ulnar artery compromise

Mallet Finger • MOI – Direct blow to extended finger • S/S – Pn at DIP – unable to extend finger • TX – RICE – Splinted 24 hr/day, 6 -8 weeks

Boutonniere Deformity • MOI – Trauma forcing the DIP into extension and PIP into flexion • S/S – Pn and inability to extend the DIP – Swelling, obvious deformity • TX – Ice – Splint PIP in extension 5 -8 weeks – Flex distal phalanx

Jersey Finger • MOI – Most often in the ring finger – Grabs a jersey, ruptures flexor tendon • S/S – DIP joint cant be flexed – Finger stuck in extension • TX – No surgery = never flex DIP again – Surgery = 12 weeks of rehab

Tap/Percussion Test • Procedure – Athlete extends affected finger – Evaluator applies a firm tap to the end of the finger • Positive Test – Pn. At injury site = possible fx