EWH

• • Usually because of a fall from an outstretched arm. Frequently does not heal turning into a nonunion fracture, because of poor vascular supply. 

  Symptoms: persistent pain in anatomic snuffbox

  SCAPHOID FRACTURE
• • Finger sprain that happens more often at the PIP joint, a severe sprain that causes dysfunction of the hand. It may lead to degenerative joint changes when not properly treated. Must be stretched to regain mobility.

  Symptoms: edema or prolonged immobilization

  JAMMED FINGER
• • Because of a fall on an outstretched arm with forearm in supination or by a sudden hyper extension force applied to the wrist. Pain is located in the ulnar wrist

  Symptoms: occurs with ROM of wrist and forearm (especially forearm), painful gripping, painful crepitus or clicking of wrist when in motion.

  TRIANGULAR FIBROCARTILAGINOUS COMPLEX
• • Injury of extensor digitorum when ball impacts the end of a digit. The compression force of the ball causes sudden flexion of the DIP joint, which leads to a rupture on extensor tendon’s attachment on distal phalanx. taut. The last 20° of active extension is lost.

  Symptoms: distal phalanx unable to extend with the other digits and appearance of a mallet, common treatment is application of a splint allowing scar tissue to form and tendon ends to heal ( worn for about six weeks)

  MALLET FINGER
• • Destruction of a ligament by injury or diseases like rheumatoid arthritis causes disruption of the balanced forces and movement of tendons to abnormal positions.

  Symptoms: deforming of fingers

  BOWSTRINGING OF FLEXOR TENDONS
• • Difficulty in activities that require quick closure of the hand. Affected muscles are flexor digitorum superficialis and profundus

  Symptoms: “claw” posture of hand, atrophy and loss of elastic properties

  LONG STANDING PARALYSIS OF INTRINSIC MUSCLES
• • Zone III extensor tendon injuries characterized by PIP flexion and DIP extension. Diagnosis is made clinically with PIP flexion and DIP extension of a digit with presence of a positive Elson test. Occurs when the central slip of the extensor digitorum is injured at its insertion on the middle phalanx.

  Symptoms: Inability to straighten the finger at the middle joint, inability to bend the finger down, Swelling on the finger joint

  BOUTONNIERE DEFORMITY
• • Occurs usually with arthritis, with subsequent weakness of the intrinsic muscles the PIP joints deform into hyperextension. The hyperextended position of the PIP moves the lateral slips of the extensor tendon dorsally relative to the joint. This causes increased tension on the flexor digitorum profundus so the DIP joint maintains a flexed position.

  Symptoms: Stiff finger, snapping feeling when you move your finger, problems bending your middle joint

  SWAN NECK DEFORMITY
• • Compression of the ulnar nerve as it passes through its tunnel in the hand is a common injury of cyclists. The ulnar nerve is either com- pressed between the wrist bones and handlebars of the bike as the cyclist places weight on the hands or stretched when the wrist is maintained in a hyperextended position, especially during long road trips when a dropdown handlebar is grasped in the lower position.

  Symptoms: Numbness or tingling in the ring or little finger, weakness also occurs

  HANDLEBAR PALSY'S/GUYON'S CANAL SYNDROME
• • A lesser condition that affects the median nerve compared to median nerve palsy. Its when the median nerve is compressed within the carpal tunnel. Caused  by repetitive or prolonged wrist flexion or extension. Swelling may also cause this syndrome, may be because of arthritis, hypothyroidism, diabetes or pregnancy.

  Symptoms: numbness or tingling along the median nerve distribution in the hand, possible weakness of muscles innervat- ed by the nerve, and sleep disturbances secondary to pain

  CARPAL TUNNEL SYNDROME
• • You will probably feel pain when you turn your wrist, grasp anything or make a fist. Tested using finkelstein’s test. It is chronic overuse of the wrist. Repetitive movements day after day cause irritation and pain. Like lifting heavy shopping bags. Affected muscles are abductor pollicis longus and extensor pollicis brevis tendons.

  Symptoms: Pain near the base of the thumb, Swelling near the base of the thumb, Difficulty moving the thumb and wrist when doing something that involves grasping or pinching

  DE QUERVAIN TENOSYNOVITIS
• • Swelling of the tendons that bend your wrist backward away from your palm. Is inflammation or microtearing of the tendons that join the forearm muscles on the outside of the elbow. The forearm muscles and tendons become damaged from overuse. Affected muscles are ECRL, ECRB and Brachioradialis. (common in racket sports, can lead to pain and tenderness)

  Symptoms: Pain in the: on the outside of the elbow, which may travel down the forearm when lifting or bending your arm, when gripping small objects such as a pen, when twisting your forearm

  LATERAL EPICONDYLITIS/TENNIS ELBOW
• • Is also known as baseball elbow or suitcase elbow. It's characterized by pain from the elbow to the wrist on the inside (medial side) of the elbow. The pain is caused by damage to the tendons that bend the wrist toward the palm. (caused by throwing sports). Flexor carpi radialis and pronator teres are the affected muscles

  Symptoms: Pain along the inside of your forearm from your elbow to your wrist, Pain when flexing your wrist when your palm is face down, Pain when your shake hands with someone, A weak grip

  MEDIAL EPICONDYLITIS/GOLFER'S ELBOW
• • Affected the nerves of the AFO pollicis muscles

  Symptoms: Weak AFO pollicis muscles

  8-HAND DEFORMITY
• • Affected radial nerve

  Symptoms: weakness of wrist extension and the inability to extend the fingers

  WRIST DROP
•   - It is caused by the presence of a localized swelling of one of the long flexor tendons that catches on a narrowing of the fibrous flexor sheath anterior to the MCP joint. It may take place either in flexion or in extension. In trigger finger, there is a palpable and even audible snapping when a patient is asked to flex and extend the fingers. A similar condition occurring in the thumb is called trigger thumb.

  
  

  Symptoms: localized swelling of one of the long flexor tendons that catches on a narrowing of the fibrous flexor sheath anterior to the metacarpophalangeal joint

  TRIGGER FINGER
• • Limits hand function and may eventually disable the hand. Later, the condition involves the little finger in the same manner. In long-standing cases, the pull on the fibrous sheaths of these fingers results in flexion of the proximal IP joints. The distal interphalangeal joints are not involved and are actually extended by the pressure of the fingers against the palm.

  Symptoms: localized thickening and contracture of the palmar aponeurosis, commonly starts near the root of the ring finger and draws that finger into the palm, flexing it at the MCP joint

  DUPUYTREN'S CONTRACTURE
• Rupture of this tendon can occur after fracture of the distal third of the radius. Roughening of the dorsal tubercle of the radius by the fracture line can cause excessive friction on the tendon, which can then rupture. Rheumatoid arthritis can also cause rupture of this tendon.

  Symptoms: fracture of the distal third of the radius

  RUPTURE OF EXTENSOR POLLICIS LONGUS TENDON
• As a result of repeated friction between these tendons and the styloid process of the radius, they sometimes become edematous and swell. Later, fibrosis of the synovial sheath produces a condition known as stenosing tenosynovitis in which movement of the tendons becomes restricted. Advanced cases require surgical incision along the constricting sheath.

  
  

  Symptoms: repeated friction between these tendons and the styloid process of the radius, they sometimes become edematous and swell.

  STENOSING SYNOVITIS OF APL AND EPB TENDONS
• A small subcutaneous bursa is present over the olecranon process of the ulna, and repeated trauma often produces chronic bursitis.

  (Dart throwers / Draft Man / Miner / Student's Elbow)

  OLECRANON BURSITIS
• Occasionally occurs in young adults who fall on the outstretched hand in a way that causes hyperextension of the wrist joint. Involvement of the median nerve is common.

  DISLOCATION OF LUNATE
• can occur as a result of direct violence, such as the clenched fist striking a hard object. The fracture always angulated dorsally.

  FRACTURES OF METACARPAL BONES
• common, and most are posterior. Posterior _ usually follows falling on the outstretched hand. Posterior _ of the joint are common in children because the parts of the bones that stabilize the joint are incompletely developed.

  Symptoms: falling on the outstretched hand

  DISLOCATION OF ELBOW JOINT
• In _, forces are transmitted from the scaphoid to the distal end of the radius, from the radius across the interosseous membrane to the ulna, and from the ulna to the humerus; thence, through the glenoid fossa of the scapula to the coracoclavicular ligament and the clavicle; and finally, to the sternum. If the forces are excessive, different parts of the upper limb give way under the strain.

  FALLS ON OUTSTRETCHED HAND
• The roots, trunks, and divisions of the _ reside in the lower part of the posterior triangle of the neck, whereas the cords and most of the branches of the plexus lie in the axilla. Complete lesions involving all the roots of the plexus are rare. Incomplete injuries are common and are usually caused by traction or pressure; individual nerves can be divided by stab wounds.

  Symptoms: traction or pressure; individual nerves can be divided by stab wounds.

  BRACHIAL PLEXUS INJURIES
• radial nerve/spiral groove= wrist drop

  SPIRAL FRACTURE
• axillary nerve

  HUMERAL NECK FRACTURE
• radial head dislocation + ulnar shaft fracture

  MONTEGGIA FRACTURE
• ulnar head dislocation + radial shaft fracture

  GALEAZZI FRACTURE
• dinner fork deformity/ dorsal displacement

  COLLE'S FRACTURE
• Garden spade deformity/ volar displacement

  SMITH'S FRACTURE
• 5th metacarpal fracture?

  BOXER'S FRACTURE
• 1st metacarpal fracture?

  BENNETT'S FRACTURE
• Damaged ulnar nerve

  CLAW HAND
• ulnar or median nerve neuropathy, 4th and 5th digits affected?

  HAND OF BENEDICTION
• Compression of median nerve

  PRONATOR TERES SYNDROME
• similar to lateral epicondylitis with the patient complaining of lateral elbow pain

  SUPINATOR SYNDROME
• When the annular ligament that holds the radius in place at the elbow joint slips and the end of the radius shifts out of position, "pulled elbow." Common in children since their connective tissue is not fully matured.

  NURSEMAID'S ELBOW