Hand Injuries

1. Mallet Finger

•          Mechanism

–        Forced flexion of distal phalanx

–        Longitudinal force of fingertip

•          Signs and Symptoms

–        Pain

–        Inability to extend the distal phalanx

–        Deformity

–        Los of function

–        Flexed finger (30 deg)

•          Evaluation

–        X-Ray

•          Special Tests

–        Tests for ROM, extension of distal phalanx

•          Diagnostic Procedures

–        Refer to ortho

–        X-Ray for avulsion fracture

2. Boutonniere Deformity

•          Mechanisms

–        Forced flexion of PIP

–        Rupture extensor tendon of middle phalanx (central slip)

•          Signs and Symptoms

–        Pt. Tenderness @ middle phalanx

–        Flex deformity of PIP

–        Inability to extend finger

–        Hyperextension of DIP

•          Diagnostic Procedure

–        Ortho

–        X-Ray for possible fracture

3. Jersey Finger

•          Mechanisms

–        Forced extension of flexed distal phalanx

•          Signs and symptoms

–        Swelling

–        Loss of function

–        Pain on volar side distal to DIP

–        Can’t fully flex DIP when hand in extension

–        Palpate mass on palm of hand

•          Special Tests

–        FDP test

–        MCP/PIP in extension

4. DeQuervain’s Syndrome (Tenosynovitis of wrist)

•          Mechanism

–        Extensive wrist motion to APL, EPB

•          Increased inflammation (thickening and narrowing of sheath)

–        Excessive radial deviation/ulnar deviation

–        Common in “gripping” sports (i.e. golf)

•          Signs and symptoms

–        Aching

–        Pain @ radial styloid which radiates into forearm

–        Inability to grip

–        Crepitus over radial styloid

–        Weakness in thumb extension and abduction

–        Localized swelling

–        Loss of strength

–        Point tenderness

–        Paresthesia

•          Special Tests

–        Finkelstein’s test

•          Diagnostic Procedure

–        Immobilize

–        Ortho

5. UCL sprain of thumb (“Gamekeeper’s thumbs”)

•          Mechanism

–        Forced abduction/hyperextension of thumb

•          Signs and Symptoms

–        Pain on A/P/RROM (abduction)

–        Loss of function

–        Tenderness over UCL

–        Hemorrhage

–        Deformity

–        Instability

•          Evaluation

–        Abduction stress of thumb (varus/valgus)

•          Special Tests

–        Abduction stress test of thumb

•          Diagnostic Procedure

–        Refer to ortho

–        X-Ray to check on possible avulsion fx