Hand and Wrist Injuries Management

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Questions and Answers

What are the indications for an X-ray in a patient with a potential sprain or strain?

A fracture or dislocation, damage to nerves or circulation, wound penetrating the joint or known bleeding disorder, a serious complication such as haemarthrosis or septic arthritis, tendon rupture, or a complete tear or tear of more than half the muscle belly.

What is the algorithm for managing sprains and soft tissue injuries?

P - Protection, R - Rest, I - Ice, C - Compression, E - Elevation

What analgesics are commonly used for pain management in sprains and soft tissue injuries?

Paracetamol, Cocodamol 8/500 OTC, and NSAIDs

What is the goal of exercises in managing sprains and soft tissue injuries?

Return to normal function as pain allows, and consider simple strength-building exercises after function returns Signup and view all the answers

What is the purpose of splinting in finger injuries?

To provide protection and stability to the affected finger, while also ensuring circulation is not compromised Signup and view all the answers

What type of splint is typically used for wrist injuries?

A Futura splint (no thumb) or a Gauntlet splint Signup and view all the answers

What are the three components of physical assessment in hand injuries?

Look, Feel, Move Signup and view all the answers

What is the characteristic of a Scaphoid Fracture that makes it challenging to diagnose?

It may not be seen on initial x-ray and can be very subtle with minimal swelling and bruising. Signup and view all the answers

What is the typical angulation of a Smith's Fracture?

Volar angulation Signup and view all the answers

What is the common mechanism of injury for a Boxer's Fracture?

Axial loading of the 5th Metacarpal Signup and view all the answers

What is the characteristic of a Bennett's Fracture?

Intra-articular fracture caused by forced abduction of the thumb Signup and view all the answers

What is the most common paediatric hand fracture?

Proximal Phalanx Fracture Signup and view all the answers

What is the typical complication of a Tuft Fracture?

Loss of sensation, up to 6 months Signup and view all the answers

What is the characteristic of a Mallet Finger?

Flexion deformity of the DIPJ Signup and view all the answers

What is the purpose of Elson's Test in finger dislocations?

To assess collateral ligaments post-reduction Signup and view all the answers

What is the typical presentation of a Boutonniere Deformity?

PIPJ bent towards the palm, DIPJ bent back away (hyperextension) Signup and view all the answers

Study Notes

Assessment Refresher

Physical assessment includes:
- Look: bruises, bleeding, swelling, deformity
- Feel: bony tenderness, crepitus, sensation
- Move: passive, active, resisted
Special tests include:
- Hand Examination
- Tinnels Test and Phalens Test for Carpal Tunnel Syndrome

Common Hand Injuries

FOOSH Injuries

Scaphoid Fracture:
- Often not seen on initial x-ray
- Can be very subtle, minimal swelling and bruising
- Mechanism and physical examination are key
- Pain at the anatomical snuffbox
Colles Fracture:
- Common FOOSH injury
- Usually extra articular
- Impaction of distal radius with dorsal angulation
Smith's Fracture:
- Caused by a direct blow
- Note the volar angulation

Other Hand Injuries

Boxer's Fracture:
- Axial loading of the 5th Metacarpal
- 95% young males
- Direct blow with a solid surface
Bennet's Fracture:
- Caused by forced abduction of the thumb
- Intra articular fracture
- Stable non-displaced fractures can be placed in a thumb spica
Proximal Phalanx Fracture:
- The most common paediatric hand fracture
- Caused by forced rotation, hyperextension, or direct trauma
- Assess for scissoring and numbness
Tuft Fracture:
- Due to crush injury
- Usually stable
- Can be managed by splinting at the DIPJ
- Complication: loss of sensation, up to 6 months
Mallet Finger:
- No information provided
Finger Dislocations:
- Requires reduction
- Assess collateral ligaments post-reduction
- Elson's Test can be considered but is complex
Boutonniere Deformity:
- Caused by cut to central slip at its attachment to the bone or direct blow to the dorsal aspect of the hand
- PIPJ bent toward palm, DIPJ is bent back away (hyperextension)
- May develop up to 3 weeks post-injury

Tendonitis and Sprains

Thumb Tendonitis:
- De Quervain's tenosynovitis
- Active and Resisted Pain on Extension
- Finklestein Test
Sprains:
- Pain on Resisted/Active Movement
- Absence of Fracture/Bony Tenderness
- Usually caused by hyper-extension or direct trauma to the area
- May present or reoccur

Management of Hand and Wrist Injuries

Fracture Rules:
- No Ottawa or equivalent for the wrist that are widely used
- Typically, wrist fractures are overt and follow the pattern of injury
Sprains: What to Exclude
- Fracture or dislocation
- Damage to nerves or circulation
- Wound penetrating the joint or known bleeding disorder
- Serious complication such as haemarthrosis or septic arthritis
- Tendon rupture
- Complete tear or tear of more than half the muscle belly
- Large intramuscular haematoma
Sprains: Standard Soft Tissue Advice
- P - Protection
- R - Rest
- I - Ice
- C - Compression
- E - Elevation
Pharmaceutical Management:
- Analgesia (Paracetamol, Cocodamol 8/500 OTC)
- NSAID (Caution over use in 48-hour post-injury, Caution in Elderly, Topical vs Oral, Prescription vs OTC)
Excersises:
- Return to normal function as pain allows
- Consider simple strength building exercises after function returns
Splinting:
- Appropriate for most finger injuries/tendon fracture etc
- Must include circulation check
- No circumferential taping
- Give the patient supplies!

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Description

Learn about hand and wrist injuries, anatomy, assessment techniques and management strategies. Identify common injuries and understand referral processes.