Sports MedicineHand Injuries

1

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

2

Warm-Up• How many bones are in the wrist and hand? This includes the

carpal bones also.

3

Boney Anatomy of the Hand and Wrist

•Contains __ Bones• Fourteen (____)

Phalanges• Five (___)

Metacarpals• Eight (____)

Carpals***The pisiform bone is not shown in this view.***

4

Carpal Bones• Proximal Row (L-R)• Scaphoid• Lunate• Triquetral• Pisform• Distal Row (L-R)• Trapezium• Trapezoid• Capitate• Hamate

5

Articulations of The Hand

• Three different articulations• __________________• __________________• __________________

• Supported by ligaments and capsular tissues.

6

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 7

Muscles Within The Hand

• _________ Muscles (Originate in the Hand)• Responsible for _________

movements.

8

Muscles that Move The Hand

• ____________ Muscles (Originate in the forearm)

• Responsible for ______ motor movements.

9

10

11

Nerve Supply of the Hand

• Nerve Inneravtion• __________ Nerve # 3• __________ Nerve #2• ___________ Nerve # 1

12

http://anatomy.med.umich.edu/atlas/hand_cut1.html

Blood Supply to the Hand

• Blood Supply• _________ Artery• _________ Artery

13

www.ptca.org/radial/interview_jobe.html

Regions of the Hand

14

__________Eminence __________Eminence

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

15

16

Pace Lap

• What is the difference between the intrinsic muscles of the hand and the extrinsic muscles of the hand?

17

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?

18

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.

19orthoinfo.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.

20

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.

21

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.

22

Treatment

• Rest• Ice• Splint in full

___________• Refer to physician

23

http://www.allegromedical.com

physio-med.com

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.

24

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. 25

Treatment

• Rest• Ice • Splint in slight Flexion• Refer to physician immediately• This will require surgery.

26

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

27

Colles’s Fracture

28

http://www.feinberg.northwestern.edu/emergencymed/residents/ortho-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

29

Scaphoid Fracture

30

Anatomical Snuffbox

31

http://commons.wikimedia.org/wiki/File:Anatomical_snuffbox.JPG

Bennett’s Fracture

• Fracture or fracture-dislocation of the proximal end of the first metacarpal bone away from the trapezium.• Mechanism of Injury• ___________

something with a _____________ fist.

32

Signs and Symptoms

• Recent history of trauma.• Obvious deformity• __________ thumb

compared to the opposite hand.• Swelling over the first

proximal metacarpal.

33

Boxers Fracture• Fracture of the

________and/or _______ metacarpal.

34

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 35

Treatment

• Apply Ice• Splint• Buddy Tape (Anatomical Splint)• Board Splint

• Elevate• How??

• Refer to physician

36

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? 37

Gamekeepers Thumb• Term originated in the

1950’s describing an injury to gamekeepers.• Injury to the Ulnar

collateral ligament of the 1st MCP joint.

38

Gamekeepers Thumb

•May also be called Skiers Thumb• ______ of these

injuries occur in conjunction with an __________ fracture of the _________ phalange.

39

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 _______________ ____________.40

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.

41

Carpal Tunnel

42http://www.srcpt.com/blog/

Ganglion Cyst• A small hard lump above a tendon or

in the __________ that encloses a joint.

43

Boutonniere Deformity Anatomy

• _________ Bands of the extensor digitorum tendon.• Lateral (2)• Central

• Proximal Interphalangeal Joint (______)

• Allows for full flexion of the PIP joint.

44

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.

45

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

46

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.

47

Treatment

• Ice•Referral for x-ray

to determine no avulsion• Splint

48

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? 49