Hand Injuries
Sports Medicine
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Daily Objectives
• Content Objectives
• List the anatomical structures responsible for movement of the hand and
phalanges.
• Gain knowledge regarding fractures of the hand.
• Language Objectives
• Read assigned pages in textbook.
• Copy notes off of power point
• Complete the Double Bubble Map
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Warm-Up
• How many bones are in the wrist and hand? This includes the
carpal bones also.
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Boney Anatomy of the Hand and
Wrist
• Contains __ Bones
• Fourteen (____)
Phalanges
• Five (___)
Metacarpals
• Eight (____)
Carpals
***The pisiform bone is not
shown in this view.***
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Carpal Bones
•
•
•
•
•
•
•
•
•
•
Proximal Row (L-R)
Scaphoid
Lunate
Triquetral
Pisform
Distal Row (L-R)
Trapezium
Trapezoid
Capitate
Hamate
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Articulations of The Hand
• Three different
articulations
• __________________
• __________________
• __________________
• Supported by ligaments
and capsular tissues.
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Movements of the Wrist and Hand
•
•
•
•
•
•
•
•
•
•
•
•
Wrist Flexion
Wrist Extension
Radial Deviation
Ulnar Deviation
Finger Flexion
Finger Extension
Finger Abduction
Finger Adduction
Thumb Flexion
Thumb Extension
Thumb Abduction
Opposition
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Muscles Within The Hand
• _________ Muscles
(Originate in the Hand)
• Responsible for _________
movements.
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Muscles that Move The Hand
• ____________
Muscles (Originate in the
forearm)
• Responsible for ______
motor movements.
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10
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Nerve Supply of the Hand
• Nerve Inneravtion
• __________ Nerve # 3
• __________ Nerve #2
• ___________ Nerve # 1
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http://anatomy.med.umich.edu/atlas/hand_cut1.html
Blood Supply to the Hand
• Blood Supply
• _________ Artery
• _________ Artery
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www.ptca.org/radial/interview_jobe.html
Regions of the Hand
__________Eminence
__________Eminence
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Injury Information
• Very Common in Athletics
• Injuries can be of a large variety
• Fractures
• Sprains and Dislocations
• Tendon Strains and Ruptures
• Often occurring in the following sports:
• Baseball
• Softball
• Basketball
• Football
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Pace Lap
• What is the difference between the intrinsic
muscles of the hand and the extrinsic muscles of
the hand?
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Assignment
• Read pages 434-436 and complete the
following.
• Why do athletes have a greater risk of injury to the
hands ?
• What two anatomical structures set humans apart
from other animals?
• Complete a Double bubble map comparing and
contrasting a mallet finger with a jersey finger.
• Where is the anatomical snuffbox located, and why is
it significant when evaluating a hand injury?
• What is a Colles’s Fracture?
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Finger Fracture
• Can involve any
phalange.
• Proximal, Middle, or
Distal Phalange.
• Needs to evaluated by
a physician
• Most can be treated
with splints or buddy
tape.
• Displaced or open
fractures will need to
be surgically repaired.
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orthoinfo.aaos.org/topic.cfm?topic=A00010
Mallet Finger
• Injury to the
___________tendon
of the distal
interphalangeal joint
of the finger.
• Gives the ____ joint
an appearance of a
mallet.
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Mallet Finger
• AKA: Baseball Finger
• Involves the __________ Digitorum Tendon.
(___________)
• Mechanism of Injury
• Tip of the finger gets hit exactly as it is being
extended from a flexed position.
• The extensor digitorum is taught and
simultaneously forced into ___________.
• This results in an avulsion of the tendon
away from it’s insertion at the base of the
distal phalange.
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Signs and Symptoms
• Deformity of the _____
joint.
• Inability to extend the
DIP joint.
• Obvious deformity of the
DIP joint
• Recent trauma to the
fingertip
• Point tenderness on the
_________ surface of the
distal phalange where the
ED muscle attaches.
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Treatment
• Rest
• Ice
• Splint in full
___________
• Refer to physician
http://www.allegromedical.com
physio-med.com
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Jersey Finger
• Also involves the tearing
of a finger tendon away
from the bone.
• The ________ digitorum
profundus (FDP) tears
away from its
attachment on the distal
phalange.
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Jersey Finger
• Mechanism of Injury
• Catching a finger in an opponents
clothing
• Signs and Symptoms
• __________ to flex the ____ joint.
• Athlete reports having felt something
“pop or snap” in the fingertip.
• Point tenderness on the ________
(palmar) surface of the distal phalange.
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Treatment
• Rest
• Ice
• Splint in slight Flexion
• Refer to physician immediately
• This will require surgery.
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Colles’s Fracture
• Fracture of the ___________radius.
• Mechanism of Injury
• Forced wrist ___________. Usually from trying to break a
fall.
• Signs and Symptoms
• Obvious deformity over the distal radius.
• Pain with forearm pronation/supination, and wrist
flexion/extension. (________________________)
• Athlete will have felt a “pop” or “snap”.
• Treatment
• Ice
• Splint
• Refer to physician
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Colles’s Fracture
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http://www.feinberg.northwestern.edu/emergencymed/residents/ort
ho-teaching/case52/case52background.html
Scaphoid Fracture
• Fracture of the ___________-bone
• Mechanism of Injury
• Forced wrist hyperextension. Usually from trying to break a fall.
• ___________
• Signs and Symptoms
• Point tenderness in the _________________ ___________________.
• Athlete remembers feeling a “_______” or “_________”
• Pain with all wrist movements
• Treatment
• Ice
• Splint
• Refer to physician
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Scaphoid Fracture
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Anatomical Snuffbox
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http://commons.wikimedia.org/wiki/File:Anatomical_snuffbox.
JPG
Bennett’s Fracture
• Fracture or fracturedislocation of the
proximal end of the first
metacarpal bone away
from the trapezium.
• Mechanism of Injury
• ___________
something with a
_____________ fist.
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Signs and Symptoms
• Recent history of
trauma.
• Obvious deformity
• __________ thumb
compared to the
opposite hand.
• Swelling over the first
proximal metacarpal.
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Boxers Fracture
• Fracture of the
________and/or
_______ metacarpal.
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Boxers Fracture
• More common than Bennett’s fracture
• Mechanism of Injury
• Striking something with a clinched fist
• Crushing force
• Signs and Symptoms
• Recent history of trauma
• Pain and swelling over the distal fourth
and/or fifth metacarpal.
• _____________ deformity
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Treatment
• Apply Ice
• Splint
• Buddy Tape (Anatomical Splint)
• Board Splint
• Elevate
• How??
• Refer to physician
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Reading Assignment
• Read the section titled “ Boutonniere Deformity” on pages 438-445
and complete the following:
1. What is gamekeepers thumb?
2. What is Carpal Tunnel Syndrome?
3. Which nerve is involved in Carpal Tunnel
Syndrome?
4. Define Ganglion Cysts.
5. What is a boutonniere deformity?
6. How does this differ from a mallet finger?
7. What articulation is involved with a boutonniere
deformity?
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Gamekeepers Thumb
• Term originated in the
1950’s describing an
injury to gamekeepers.
• Injury to the Ulnar
collateral ligament of
the 1st MCP joint.
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Gamekeepers Thumb
• May also be called
Skiers Thumb
• ______ of these
injuries occur in
conjunction with an
__________
fracture of the
_________
phalange.
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Gamekeepers Thumb
• Mechanism of Injury
• __________ force applied to the lateral
aspect of the 1st MCP joint.
• Signs and Symptoms
• Significant point tenderness over 1st MCP
joint.
• Athlete will report having felt a “_______”
in his/her thumb.
• Significant swelling over the 1st MCP joint
and _______________ ____________.
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Carpal Tunnel Syndrome
• An _________ disorder caused by inflammation of the tissues and
__________ surrounding the _____________ nerve as it passes
through the carpal tunnel.
• _______________ Tunnel: A passage way that runs from
the forearm through the wrist.
• Mechanism of Injury
• __________
• Signs and Symptoms
• Pain, numbness, tingling, and weakness in the wrist, hand, and
fingers.
• Treatment
• RICE
• Surgical decompression of the carpal tunnel.
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Carpal Tunnel
http://www.srcpt.com/blog/
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Ganglion Cyst
• A small hard lump above a tendon or
in the __________ that encloses a
joint.
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Boutonniere Deformity Anatomy
• _________ Bands of the
extensor digitorum tendon.
• Lateral (2)
• Central
• Proximal Interphalangeal Joint
(______)
• Allows for full flexion of the PIP
joint.
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Boutonniere Deformity
• Tearing of the ______
band of the
___________tendon.
• Mechanism of Injury
• Forced finger
_______ while the
fingers are in a
flexed position
trying to extend.
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Boutonniere Deformity
• If not treated the PIP
joint will pop through the
________ portion of the
torn extensor tendon.
• This results in flexion at
the PIP joint and
hyperextension at both
_____ and _______
Joints
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Signs and Symptoms
• Athlete will report feeling a
“____________”
associated with forced
finger flexion.
• Significant weakness with
______ extension.
• Painful and swollen ____
joint.
• If unattended there will be
an obvious ___________
develop.
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Treatment
• Ice
• Referral for x-ray
to determine no
avulsion
• Splint
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Scenario Assignment
• As softball player reports to the athletic
training room complaining of pain in her 3rd
distal phalange of her throwing hand. She
states that when she tried to catch a ground
ball she put her throwing hand in front of the
glove (bad idea), and the ball hit the end of her
fingertip. She reports feeling a “pop” and
immediate pain over her dorsal DIP joint. There
is mild swelling and the athlete can no longer
extend the DIP joint of her finger. *What type
of injury are you most likely dealing with?
*How are you going to treat this? *Is this going
to affect her swimming career?
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