| A | B |
|---|
| Schaphoid fracture | • If not treated with proper immobilization fractured pieces of bone may not reunite • Nonunion fracture o Failure of fracture fragments to unite or heal o Portion of bone that is separated from blood supply may potentially become necrotic which is precursor of long term problems Signs and symptoms • Mild to moderate pain • Possible swelling • Tenderness in anatomic snuffbox (where the scaphoid is palpable) • Decreased ROM or pain with ROM Treatment • Immobilization • X-rays o Often does not appear until 10-14 days post injury • Casting 6-8 wks • Cleared to participate with cast as tolerated if padded • Once cast removed tape or brace wrist to protect • Nonunion fracture often requires surgery to reset and pin the bone fragments into proper position |
| Hamate fracture | Signs and symptoms • Mild to moderate pain • Decreased ROM • Decreased strength • Possible swelling treatment • x-rayed • immobilized with cast • rtp as symptoms allow with appropriate padding covering cast, unlikely in a bat or racket sport • after cast removed (6-8wks) hamate protected with taping and padding over injured area |
| wrist dislocation | • rare in athletics • lunate most frequently dislocated carpal bone o moves toward the palmar side of wrist and place pressure on tendons and nerves in carpal tunnel signs and symptoms • moderate pain • possible deformity • decreased ROM • possible numbness in the hand treatment • referred for reduction • immobilized with cast for 6-8 wks • after taped or braced during competition |
| TFCC sprain | • located between carpal bones and ulna • major stabilizer for wrist providing rotation and shock absorption signs and symptoms • mild to moderate pain usually on ulnar side of wrist • decreased ROM • clicking or popping sound with motion • possible swelling treatment • similar to fracture/dislocation • refer for diagnostic testing immobilized with cast • may play with cast on depending on sport • after cast removed progressive ROM and strengthening exercises to rehab injury and protect wrist from further damage |
| wrist sprain | • most common injury at this joint • injury that occurs at ligament of wrist signs and symptoms • mild to moderate pain • possible swelling • decreased ROM treatment • rule out fracture • cold and electric modality therapy • hand and wrist strengthening to prevent re-injury • taped/braced when RTP • cleared when symptoms subside enough to compete |
| tendonitis/carpal tunnel syndrome | signs and symptoms • mild pain and discomfort • decreased ROM • decreased strength • possible swelling • numbness and tingling in fingers treatment • RICE • Ultrasound • Splinting • Anti-inflammatory medicine • ROM and strengthening exercises and evaluate his or her activity for improper biomechanics • Severe cases may require surgery • RTP when symptoms subside and to athlete’s tolerance |
| Metacarpal fractures | Signs and symptoms • Moderate pain • Possible deformity • Possible swelling • Crepitus Special tests • Tap, compression, rotation test for fractures o + increase in pain • should not be done with obvious deformity treatment • referred for xrays and casting • may require surgery to reset and pin bone • cast left on 4-6 wks • ROM and strengthening exercises when cast removed • RTP with cast as symptoms allow |
| Phalangeal fractures | • Happen frequently • May continue play if pain and other symptoms tolerable Signs and symptoms • Mild to moderate pain • Possible swelling • Possible deformity • Decreased ROM • Decreased strength Treatment • RICE • Splinting taping • May require casting/splinting 2-4 wks • If rotates or unstable surgery may be required • If surgery not required RTP as symptom allow o Fingers buddy taped or braced until symptoms resolve • 4- wks post injury • surgical recovery up to 12 wks |
| finger dislocation | • can occur at MCP,PIP,DIP signs and symptoms • moderate pain • obvious deformity • possible swelling and discoloration • decreased ROM • decreased strength treatment • trained professional reduce finger o anyone else could cause neurovascular damage • once reduced taped or splinted • x rayed to rule out a fractures • RTP as symptoms have diminished • Taped or braced during activity at least 2-4 wks to avoid repeat |
| Gamekeeper’s thumb | • Injury to ulnar collateral ligament at the MCP joint of thumb Signs and symptoms • Moderate pain • Joint laxity with valgus stress • Decreased ROM • Decreased strength Special test • Pinch test o Manual muscle test of thumb o + test with increased pain or decreased strength in thumb • valgus stress test for thumb o +pain and joint laxity indicate sprain or tear treatment • referred for follow-up and possible surgery if ligament is completely torn and joint is unstable • no surgery than given thumb splint or removable cast to protect o used 2-4 wks or until symptoms resolve o may play with splint as tolerated o once splint removed taped |
| finger sprain | signs and symptoms • pain relative to the degree of injury • possible swelling • decreased ROM • decreased strength treatment • RICE • RTP as symptoms allow and with taping or bracing • More serious injuries may require increased time and rehab to strengthen joint |
| Mallet finger | • Rupture of the extensor tendon Signs and symptoms • Mild to moderate pain in distal phalanx • Obvious deformity-distal phalanx is flexed at a 30 degree angle • Loss of ROM/inability to extend DIP joint Treatment • RIICE for swelling • Splint for full recovery • Braced in full extension 6-8 wks to allow tendon to reattach to bone o If not used will permanently lose extension of distal phalanx • RTP as symptoms resolve with proper splinting to prevent further damage |
| Jersey finger | • Rupture of flexor tendon from the distal phalanx Signs and symptoms • Mild to moderate pain • Loss of ROM in flexion for distal phalanx • Decreased strength Treatment • Cant flex finger or make a fist must be repaired surgically to regain function which needs to occur within 10 days to ensure optimal recovery o If postponed risk tendon degradation making reattachment either impossible or difficult • Rehab requires 10-12 wks using progressive ROM exercises and finger strengthening • ROM difficult at first RTP possible following rehab if braced or taped |
| Boutonneire deformity | • When extensor tendon ruptures at its attachment to the middle phalanx Signs and symptoms • Moderate pain and discomfort • Loss of any ROM • Obvious deformity Treatment • Splinted with PIP joint in extension for 6-8 wks • Failure to splint injury result in permanent deformity of the finger • Rehab exercises to focus on DIP joint flexion • RTP may occur as symptoms resolve and with the appropriate splinting |
| Swan Neck deformity | • Not technically tendon injury • Occurs as result of severe hyperextension causing the volar plate of the PIP joint to shift or tear. • Shifting causes painful hyperextension at pip joint, which forces the finger into eh shape of swan neck Signs and symptoms • Moderate pain • Obvious deformity • Loss of ROM Treatment • Conservative with splinting and RICE • After 3-6 wks splint removed and Buddy taped and progressive rehab regiment started • RTP as soon as symptoms allow with proper splinting and protection • Surgery if consistently recurs or proper healing does not take place |
