hands/wrist

• Finkelstein test


  Ask patient to make fist with fingers closed over the thumb, then ask patient to deviate wrist toward little finger. Test is considered positive if the patient reports pain at the radial styloid with active or passive wrist deviation.
• Phalan's test


  Hyperflex wrist, keeping flexed for up to 60 secs, assessing pt for tingling/numbness (more often=worse)
• Tinnels test


  Tingling sensation in area of median nerve distribution provoked by finger percussion at compression site (pos=tingling w percussion of carpal tunnel of volar aspect of sus wrist)
• Allen's test


  Squeeze fist and cover arteries on both sides→open fist and see capillary refill time. 5-15 sec is normal
• Snuffbox tenderness is indicative of scaphoid fractures
• Malrotation


  Easily missed and may lead to functional impairment if not formally addressed. Normal alignment is confirmed with all the fingers pointing to the scaphoid while all The PIPs/DIPs are flexed
• Types of fractures


  • Spiral
  • Angulated
  • Transverse
  • Greenstick
  • Comminuted
• Spiral fracture


  Fracture spirals AROUND the bone
• Angulated fracture


  Amount of bend at the fracture, described with respect to apex of angle or with respect to direction of distal fragment
• Transverse fracture


  Fracture extends across the bone or perpendicular to the shaft of the bone
• Greenstick fracture


  Incomplete fracture in which the bone bends and breaks on ONE side; bowing of the cortex (long bones of peds)
• Comminuted fracture


  Bone break is present in 2 or more parts with multiple fractures (CRUSHED)
• Displaced fractures determine stability (non displaced is best). Fragments can be rotated around axis angulated or translated (laterally moved)
• Buckle/torus fracture


  Compression of two bones driven into each other; bulging of the cortex, is a stable fracture (cast it)
• Scaphoid fracture


  Commonly fractured carpal bone due to FOOSH in M. This is where blood flow from radial artery enters so with poor blood supply, avascular necrosis risk
• Boxer fracture


  Fracture of the fifth metacarpal neck (maybe 4th); strong axial force caused by direct impact with closed or clenched fist (aka punch)
• Distal ulnar fracture


  From direct trauma to forearm (youth sports), Nightstick fracture= isolated fx of ulna occurs normally in conjunction with distal radius fractures
• Distal radius fracture


  Any fracture through metaphysis, most common (W) Peds due to high energy activity (injury), older pt is FOOSH aka low energy mechanism
• Bennett fracture


  Partial intra-articular fracture of the base of the first metacarpal bone which extends into the CMC joint; nearly always has some degree of subluxiation/frank dislocation of CMC joint (thumb!!!!)
• Tuft fracture/Distal phalanx fracture

  Crush injury or sports associated with nail bed injury and open fracture; can be transverse/longitudinal fracture
• Colles fracture


  Distal radial fracture with dorsal angulation; FOOSH with wrist in dorsiflexion
• Smith fracture


  Reverse Colles, distal radial fracture with volar angulation "garden spade deformity"; fall on flexed wrist with forearm fixed in supination
• Monteggia fracture


  Proximal third of ulna associated with anterior dislocation of the radial head; due to FOOSH in excessive pronation
• Galeazzi fracture


  Distal third of radius with dislocation or subluxation of the distal radioulnar joint; FOOSH on hyperpronated arm
• Rolando fracture


  Comminuted complete intra-articular first metacarpal fracture with dislocation of radial and ulnar fragments resulting in a Y- or T- shaped intra-articular fragment (JUST LIKE BENNETT'S)
• Gamekeeper's/Skier's thumb


  Ulnar collateral ligament (UCL) injury; typically chronic overuse or acute from a skier FOOSH on pole with thumb snap back
• Mechanism of injury for common fractures and/or injuries in the hand and wrist is FOOSH or sports trauma, direct trauma
• RICE treatment


  Rest/Ice/Compress/Elevate; without getting cast/split wet
• Monitor the patient's injury before, during and after splinting: Function, Arterial pulse, Capillary refill, Temperature of skin, Sensation
• Salter-Harris fracture


  Fracture involving the epiphyseal growth plate
• Types of Salter-Harris fractures

  • Type 1: straight across (through hypertrophic zone), uncommon growth disturbance
  • Type 2: through physis (growth plate) and metaphysis, but epiphysis not involved; MOST COMMON
  • Type 3: intra-articular fracture extending from physis into epiphysis, inevitably damaging the reproductive layer of the physis; older kids who have growth plates that have started to close
  • Type 4: intra-articular fracture involving fracture through all 3 elements of the bone: epiphysis, physis and metaphysis; interferes with growing layer of cartilage cells→premature focal fusion of involved bone→deformity of joint and maybe chronic disability
  • Type 5: compression fracture of growth plate; stress injury; closes growth plate, normally diagnosed when limbs are shorter
• Carpal tunnel syndrome


  Mononeuropathy caused by repetitive movement, vibrations, tenosynovitis, sprains, strains, ganglion cysts, wrist fractures, infection. Symptoms include night pain, numbness, paresthesia, clumsiness, motor weakness in hand.
• Mallet finger


  Extensor DIP tendon injury from trauma, can lead to swan neck deformity if untreated
• Boutonniere deformity


  PIP flexion and DIP extension from trauma of a rupture of central slip over PIP
• De Quervain's tenosynovitis


  Repetitive twisting of the wrist, gradual onset of pain around base of thumb along radial side of dominant wrist
• Nursemaid's elbow


  Radial head subluxation (pulled elbow), common in children 1-4yo from sudden traction on distal radius
• Finger and hand infections can be caused by bite wound, hangnail picking, penetrating trauma, HSV infection, joint disease, IVDA, alcoholism, immunosuppression. Symptoms include marked erythema, warmth, pain, swelling, abscess formation, rapid, pruritus