Fingers and wrist.
Now on to the fingers and wrist. Almost all of us have “jammed” a finger or possibly sprained a wrist before. Probably the most common is the simple finger sprain or injury to the fibers ligament/joint capsule) surrounding the distal and proximal interphalangeal joints. In athletics, it is seen when the tip of the finger is hit by a ball or an opponent. In these scenarios it’s sometimes difficult to discern whether there is a simply a soft tissue injury like a sprain or a fracture. Normally the care is the same: Initial splinting to support the joint and treatment to reduce the symptoms (Ice, NSAIDs). Generally if the pain is not improving in 2-3 days an x-ray should be sought to rule out fractures. I have had several instances when I had a student-athlete sprain a finger joint and because of the amount if swelling and pain over the first 2-3 days I was sure there was an accompanying fracture only to have x-rays reveal no fracture.
The take home message when trying to decide if a finger/hand should be taken for an x-ray consider a couple of factors:
- Deformity. If there is deformity a fracture should be considered and a plain x-ray radiographs should be taken
- Pain level. If the pain is inconsistent with the mechanism and is not improving after 48-72 hours an x-ray should be considered
When it comes to injuries (and suspected fractures) of the hand/wrist, x-rays should be considered when there is deformity. Also because of the delicate nature of the metacarpals, carpals, and distal radius/ulna a hand orthopedic surgeon should be sought for treatment. Often the difference between surgical and non-surgical options can be the difference of 1 millimeter of bone movement.
Similarly finger tendon injuries (which usually results in either a flexion/extension finger deformity) should be seen ASAP by a finger/hand surgeon because of the need for specialty splinting for long periods of time (up to 6 weeks).
TASK/CHALLENGE FOR EVERYONE: I’d like everyone to research and post a video. I’d like everyone to post 4 videos this week EACH MUST HAVE AN EXPLANATION ACCPOMANYING THE VIDEO
– 1 video of finger splinting
-1 video 1 of finger/hand rehabilitation exercises
-1 video of wrist splinting
-1 video of wrist rehabilitation exercises
A couple more important notes for the hand/wrist:
The navicular or scaphoid bone at the base of the thumb always needs special attention when an injury is considered. The scaphoid is easy to find on a patient by palpating what is called the anatomical snuff box. Here is a video on palpation:
Because the scaphoid does not have a good blood supply in all positions special casting (or surgical pinning) is required for proper healing. If optimal blood supply is not achieved avascular necrosis (bone death) can occur. Casting for scaphoid fractures is very specific in how the thumb needs to be positioned. Here is a video detailing casting:
Lastly carpal tunnel syndrome is one of the highest lost time injuries for the workforce. Fortunately the surgery to correct the condition can now be done under 15 minutes and with a local anesthetic with very good results. Here is a good video demonstrating the surgery: