Hand and Wrist Injuries and Conditions Julia Wild Hand Therapist www.southernhandtherapy.com.au 02 9553 8597
POSI Position of Safe Immobilisation So everything is balanced Wrist 30⁰ ext MCP 70⁰ flex for the collateral ligament IP 0⁰
Wrist Injuries # radius CRPS # scaphoid DeQuervains Wrist sprain Dorsal Carpal Ganglion Carpal Tunnel Syndrome TFCC ECU tendonitis
Wrist Cast Full finger flex in 1 week Swelling longer? # position slipped? CRPS Pain Clinic immediately and change cast to another or wrist splint
Wrist Splint Narrow but contouring palmar bar All commercial wrist splint come with 30 wrist ext in aluminium bar SOUTHERN HAND THERAPY
Assess in sections Radial Volar Ulnar Dorsal
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
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
DeQuervains Finklestein test Splint include wrist & thumb
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
Volar Wrist
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
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
TFCC Articular disc central and peripheral Meniscus homologue Radio-ulnar ligamanet Ulnar collateral ligament ECU Assessed MRI and arthroscope
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
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
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
Dorsal Carpal Ganglion Can be intermittent Female ganglions 45 % not all sore Wrist splint for 4 weeks Inject ganglion Recurrent painful need surgery
Avulsion chip # carpus Splint/cast 6 weeks
Dorsal Wrist 6 4 3 2
THUMB MCP Adductor Pollicus Ulnar Collateral Ligament SOUTHERN HAND THERAPY
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
UCL Conservative Treatment 6 weeks 24/24 protected with no dev in MCP Short Thumb Splint 6-10 weeks for sport only
Volar plate tear MCP 6 weeks 24/24 protected with slight MCP flex Short Thumb Splint 6-10 weeks for sport only
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
# MC mid shaft or proximal Undisplaced 4 weeks protected Buddy strap 4-6 weeks
# MC neck or head
Trigger Finger
# Phalanges Spiral Review 2 weeks Check rot Oblique Review 2 weeks Check rot Transverse -stable Displaced refer on
# Phalanges undisplaced
PIP soft tissue Central slip Volar plate Collateral lig Joint subluxation #
# PIP injuries
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
Collateral Ligament testing Place PIP in slight flexion and apply deviating force. If gap 30⁰ than 3 rd degree tear
Volar plate tear SOUTHERN HAND THERAPY
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
FDP rupture
Jersey Finger= Flexor Digitorum Profundus avulsion Ruptured FDP is lack of DIP flexion Usually ring finger Oztag Operative Hand Surgery SOUTHERN HAND THERAPY
Ruptured FDP can pull through pulleys and get caught on A1 pulley = tender in palm A4 A2 A1 SOUTHERN HAND THERAPY
Test FDP intact Test FDS intact Tenderness along finger to palm may indicate partial tear or retracted tendon SOUTHERN HAND THERAPY
Pulley Injuries Rock-climbing hand grips place unreasonable strain on flexor tendon pulleys Full active finger ROM Tender over A2 pulley SOUTHERN HAND THERAPY
Pulley Treatment Support the pulley using thermoplastic semi-circle and Velcro Splint worn for minimum 4 weeks SOUTHERN HAND THERAPY
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
Mallet Finger SOUTHERN HAND THERAPY
Soft tissue Mallet Splint wear for minimum 8 weeks
# 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
Mallet Finger Zimmer splint Tape on 2 circumferential and 1 longitudinal from volar to dorsal Needs retaping every few days Keep dry
Rhenatherm Can shower x1/day Tape to stop distal migration of the tape
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
Resources AHTA wwww.ahta.com.au Rehabilitation of the Hand & Upper Limb by R Prosser, WB Conolly www.mayo.com www.southernhandtherapy.com.au www.mayo.comwww.mayo.com Interactive Hand Therapy edition by JC Colditz, DA McGrouther and JM Harris
Australian Hand Therapy Association www.ahta.com.au