The Forearm,Wrist, and Hand

Sports Medicine 2Sports Medicine 2

Anatomy

Bones-Bones- MetacarpalsMetacarpals Radius and UlnaRadius and Ulna

Muscles-Muscles- Flexor carpi radialis – flexes and abductsFlexor carpi radialis – flexes and abducts Flexor carpi ulnaris – flexes and adductsFlexor carpi ulnaris – flexes and adducts Extensor carpi radialis (brevis and longus) – extends Extensor carpi radialis (brevis and longus) – extends

and abductsand abducts Extensor carpi ulnaris – extends and adductsExtensor carpi ulnaris – extends and adducts Palmaris longus – flexesPalmaris longus – flexes

Forearm Fractures

MOI: MOI: Blow or fall on the outstretched armBlow or fall on the outstretched arm

S&S: audible pop or crack, pain, swelling, S&S: audible pop or crack, pain, swelling, and disabilityand disability

TX: RICE, Splinting and castingTX: RICE, Splinting and casting

Colles’ Fracture

MOI: Fall on outstretched handMOI: Fall on outstretched hand S&S: Forward displacement of the radius, S&S: Forward displacement of the radius,

others are same as forearm fractureothers are same as forearm fracture TX: RICE, and castingTX: RICE, and casting

Wrist Tenosynovitis

MOI:MOI: Repetitive wrist acceleration and Repetitive wrist acceleration and

decelerationdeceleration Inflammation of the sheath around the Inflammation of the sheath around the

extensor carpi radialis longus and brevisextensor carpi radialis longus and brevis S&S: pain (active and passive stretching), S&S: pain (active and passive stretching),

tenderness over tendonstenderness over tendons TX: Ice massage, NSAIDS, and restTX: Ice massage, NSAIDS, and rest

Tendonitis

MOI:MOI: Overuse of the wristOveruse of the wrist

S&S: Pain on active or passive stretch and S&S: Pain on active or passive stretch and weaknessweakness

TX: RICE, NSAIDSTX: RICE, NSAIDS

Carpal Tunnel Syndrome

Carpal tunnel is located on the anterior Carpal tunnel is located on the anterior aspect of the wristaspect of the wrist

MOI: Repetitive wrist flexionMOI: Repetitive wrist flexion S&S: Sensory and motor deficitsS&S: Sensory and motor deficits TX: PRICE, sometime surgeryTX: PRICE, sometime surgery

De Quervain’s Disease

Stenosing tenosynovitis in the thumbStenosing tenosynovitis in the thumb MOI:MOI:

OveruseOveruse S&S: S&S:

Aching painAching pain TX: TX:

Immobilization, RICE, NSAIDSImmobilization, RICE, NSAIDS

Dislocation of Lunate Bone

MOI: MOI: Forceful hyperextension of the wristForceful hyperextension of the wrist

S&S:S&S: Pain, swelling, and difficulty executing wrist Pain, swelling, and difficulty executing wrist

and finger flexionand finger flexion TX:TX:

Ice and send to DR. for reductionIce and send to DR. for reduction If not properly treated necrosis of the bone is If not properly treated necrosis of the bone is

likelylikely

Hamate Fracture

MOI:MOI: Fall on outstretched arm, racket sportsFall on outstretched arm, racket sports

S&S:S&S: Wrist pain and weakness, and point Wrist pain and weakness, and point

tendernesstenderness TX:TX:

Cast and padding or removal of hookCast and padding or removal of hook

Scaphoid Fracture

MOI:MOI: Hyperextension of wristHyperextension of wrist

S&S:S&S: Pain and point tenderness in “snuff box”Pain and point tenderness in “snuff box”

TX:TX: Surgery to fixateSurgery to fixate

Wrist Ganglion

MOI:MOI: Synovial cystSynovial cyst Usually occurs on the back of wrist after wrist Usually occurs on the back of wrist after wrist

strainstrain S&S:S&S:

Occasional pain and a lumpOccasional pain and a lump TX:TX:

Surgical removal, aspiration, or bursting with Surgical removal, aspiration, or bursting with pressure pad afterwardspressure pad afterwards

Mallet Finger

MOI:MOI: Blow that strikes the tip of the finger causing a Blow that strikes the tip of the finger causing a

jamming or avulsion of the extensor tendonjamming or avulsion of the extensor tendon S&S:S&S:

Pain on the interphalangeal joint, deformityPain on the interphalangeal joint, deformity TX:TX:

RICE and splintingRICE and splinting

Boutonniere Deformity

Extension of DIP AND Flexion of PIPExtension of DIP AND Flexion of PIP MOI:MOI:

Rupture of the extensor tendon dorsal to the Rupture of the extensor tendon dorsal to the middle phalanxmiddle phalanx

S&S:S&S: Severe pain and inability to extend DIP jointSevere pain and inability to extend DIP joint

TX:TX: RICE, and splintingRICE, and splinting

Jersey Finger

MOI:MOI: grabbing a jersey or opponent and grabbing a jersey or opponent and

tendon rupturestendon ruptures S&S:S&S:

DIP joint cannot be flexedDIP joint cannot be flexed TX:TX:

Surgically repairedSurgically repaired

Gamekeepers Thumb

MOI:MOI: UCL Sprain of the thumbUCL Sprain of the thumb Forced hyperextensionForced hyperextension

S&S:S&S: Pain, weaknessPain, weakness

TX:TX: RICE, SplintRICE, Splint

Swan Neck Deformity

MOI:MOI: Severe hyperextensionSevere hyperextension

S&S:S&S: Pain and swelling in PIP jointPain and swelling in PIP joint

TX:TX: RICE, splinting in 20-30 degrees flexionRICE, splinting in 20-30 degrees flexion

Bennett’s Fracture

MOI:MOI: Fracture at the carpometacarpal jointFracture at the carpometacarpal joint Axial load and abductionAxial load and abduction

S&S:S&S: Pain and swelling over base of thumbPain and swelling over base of thumb

TX:TX: SurgerySurgery

Boxer’s Fracture

MOI:MOI: Fracture to the 5Fracture to the 5thth metacarpal metacarpal

S&S:S&S: Pain, point tenderness, swellingPain, point tenderness, swelling

TX:TX: Surgery to pinSurgery to pin