Hand and Wrist Injuries and Conditions

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1 Hand and Wrist Injuries and Conditions Julia Wild Hand Therapist

2 POSI Position of Safe Immobilisation So everything is balanced Wrist 30⁰ ext MCP 70⁰ flex for the collateral ligament IP 0⁰

3 Wrist Injuries # radius CRPS # scaphoid DeQuervains Wrist sprain Dorsal Carpal Ganglion Carpal Tunnel Syndrome TFCC ECU tendonitis

4 Wrist Cast Full finger flex in 1 week Swelling longer? # position slipped? CRPS Pain Clinic immediately and change cast to another or wrist splint

5 Wrist Splint Narrow but contouring palmar bar All commercial wrist splint come with 30 wrist ext in aluminium bar SOUTHERN HAND THERAPY

6 Assess in sections Radial Volar Ulnar Dorsal

7 Radial Wrist Radius Palpation (Lister s tubercle) Grind Scaphoid snuff box Watson s test EPL EPB/APL DeQuervains syndrome Finklestein s test Palpation 1 st CMC grind STT grind Palpation joint line

8 Radial Wrist Radius Palpation (Lister s tubercle) Grind Scaphoid snuff box Watson s test EPL EPB/APL DeQuervains syndrome Finklestein s test Palpation Superficial Radial nerve 1 st CMC grind STT grind Palpation joint line

9 DeQuervains Finklestein test Splint include wrist & thumb

10 Volar Wrist Hamate hook Pisiform grind, crep Scaphoid tubercle Median Tinel s Durkan s Phalen s Ulnar nerve Tinel s Guyon s canal compression FCR / FCU FDS/FDP Arteries = Allen s test

11 Volar Wrist

12 Carpal Tunnel Syndrome P&N Numbness Night > Day +ve Durkan s, Tinel s & Phalen s Treatment Night wrist splint 0 wrist ext for 4 weeks At 2 weeks nerve glides If not relief in splint refer on

13 Ulnar Wrist Ulnar grind DRUJ Squeeze Piano key test TFCC Squeeze Ballotment Piso-triq grind ECU Length Grade /5 subluxation FCU Ulnar nerve Dorsal sensory Volar sensory/motor

14 TFCC Articular disc central and peripheral Meniscus homologue Radio-ulnar ligamanet Ulnar collateral ligament ECU Assessed MRI and arthroscope

15 Ulnar Wrist Ulnar grind DRUJ Squeeze Piano key test TFCC Squeeze Ballotment Piso-triq grind ECU Length Grade /5 subluxation FCU Ulnar nerve Dorsal sensory Volar sensory/motor

16 ECU Tendonitis Swollen tendon in 6 th dorsal wrist compartment Pain ulnar wrist Difficulty rotating forearm Treatment wrist splint 1 week ECU specific eccentric exercises If not better in 1 week then cortisone injection

17 Dorsal Wrist Radius Lister s tubercle ECRL/B insertion Length and grade EPL Lunate Scapho-lunate interval Ganglion DRUJ TFCC ballottment EDC EDM ECU palpate

18 Dorsal Carpal Ganglion Can be intermittent Female ganglions 45 % not all sore Wrist splint for 4 weeks Inject ganglion Recurrent painful need surgery

19 Avulsion chip # carpus Splint/cast 6 weeks

20 Dorsal Wrist

21

22 THUMB MCP Adductor Pollicus Ulnar Collateral Ligament SOUTHERN HAND THERAPY

23 Thumb MCP Stener s Lesion UCL tear which is trapped by adductor aponeurosis Grade 3 tear >30 Confirmed by U/S Suspicion if swelling not reduced post STPS Needs surgical repair

24 UCL Conservative Treatment 6 weeks 24/24 protected with no dev in MCP Short Thumb Splint 6-10 weeks for sport only

25 Volar plate tear MCP 6 weeks 24/24 protected with slight MCP flex Short Thumb Splint 6-10 weeks for sport only

26

27 MC # Spiral Tendency to slip review at 2 weeks Oblique Tendency to slip review at 2 weeks Transverse Relatively stable Displaced < 20⁰ Refer on, small finger can tolerate more

28

29 # MC mid shaft or proximal Undisplaced 4 weeks protected Buddy strap 4-6 weeks

30 # MC neck or head

31 Trigger Finger

32

33 # Phalanges Spiral Review 2 weeks Check rot Oblique Review 2 weeks Check rot Transverse -stable Displaced refer on

34 # Phalanges undisplaced

35 PIP soft tissue Central slip Volar plate Collateral lig Joint subluxation #

36 # PIP injuries

37 COLLATERAL LIGAMENT TEARS =BUDDY STRAPPING to prevent lateral or rotational PIP strain for 4 weeks Encourage movement avoid disuse If use sports tape avoid tearing off injured finger as reinjury on removal of tape SOUTHERN HAND THERAPY

38 Collateral Ligament testing Place PIP in slight flexion and apply deviating force. If gap 30⁰ than 3 rd degree tear

39 Volar plate tear SOUTHERN HAND THERAPY

40 Use an extension block splint Start active flexion in splint immediately At 2 weeks reshape splint to 0 and keep moving At 4/52 buddy strap until 6 weeks Strengthen after 6 weeks VOLAR PLATE TEARS SOUTHERN HAND THERAPY

41

42 FDP rupture

43 Jersey Finger= Flexor Digitorum Profundus avulsion Ruptured FDP is lack of DIP flexion Usually ring finger Oztag Operative Hand Surgery SOUTHERN HAND THERAPY

44 Ruptured FDP can pull through pulleys and get caught on A1 pulley = tender in palm A4 A2 A1 SOUTHERN HAND THERAPY

45 Test FDP intact Test FDS intact Tenderness along finger to palm may indicate partial tear or retracted tendon SOUTHERN HAND THERAPY

46 Pulley Injuries Rock-climbing hand grips place unreasonable strain on flexor tendon pulleys Full active finger ROM Tender over A2 pulley SOUTHERN HAND THERAPY

47 Pulley Treatment Support the pulley using thermoplastic semi-circle and Velcro Splint worn for minimum 4 weeks SOUTHERN HAND THERAPY

48 Mallet Finger Is the closed disruption of the terminal extensor tendon This may be rupture of the tendon or avulsion of the extensor tendon or avulsion # of extensor tendon (less than 30% of the joint and not subluxed) SOUTHERN HAND THERAPY

49 Mallet Finger SOUTHERN HAND THERAPY

50 Soft tissue Mallet Splint wear for minimum 8 weeks

51 # Mallet Dorsal avulsion fracture attached to the extensor tendon. Closed injury X-Ray to confirm # or soft-tissue Conservative management depending on size of fragment (less 30% of joint) and position of the joint Splint 6 weeks as has better blood supply Reshape after 2 days as swelling is less

52 Mallet Finger Zimmer splint Tape on 2 circumferential and 1 longitudinal from volar to dorsal Needs retaping every few days Keep dry

53 Rhenatherm Can shower x1/day Tape to stop distal migration of the tape

54 Splinting Mallet If use stax splint then need to use 2 as swelling goes down Can use aluminium strip tape end. Only DIP 0 ext

55 Resources AHTA wwww.ahta.com.au Rehabilitation of the Hand & Upper Limb by R Prosser, WB Conolly Interactive Hand Therapy edition by JC Colditz, DA McGrouther and JM Harris

56 Australian Hand Therapy Association

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