Fractures and Dislocations

Poor hand positioning, due to restrictions in the shoulder or elbow for instance, can strain the wrist and hand. Think of hand and wrist movements os the fine tuning elements of any sporting action Movement and power production with foot positioning and body posture, before being transmitted through the worm, and finally expressed through the hand.

While the tissues involved in injuries of the wrist and hand, remember that wrist and hand symptoms can also be referred from problems in the shoulder, and arm.

Fractures and Dislocations

Wrist fractures ore commonly caused by a fall onto the outstretched hand or while palming off in rugby or American football. Fractures of the radius and ulna (the bones of the forearm) cause pain, swelling, and often a deformity. These injuries ore readily identified by X-ray Treatment requires correction of any malpositioning of the bones, followed by immobilization with a cost.

Fractures can also involve the the small bones of the wrist. The most frequently fractured of these is the Sapphic, which is found on the side of the wrist, under the base or the thumb.

Spread your thumb sideways away from the rest of your hand. Running from the bock of the thumb down to the wrist you should be able to see two tendons. The hollow between these two tendons, where the wrist meets the hand, is known os the anatomical snuff box, and this is where the scaphoid lies.

It is important to know this because fractures of the scaphoid ore often misdiagnosed os wrist sprains, and the resulting inappropriate treatment can cause long-term consequences. Scaphoid fractures ore often not so Produce no visible deformity, and frequently do not show up on on initial X-roy. Any 'wrist sprain' with pain on the thumb side of the wrist, which does not resolve itself, should hove o second X-roy two weeks after the injury.

Scaphoid fractures require on extensive cost, from the middle of the upper arm to part way down the thumb. At least partial immobilization is often required for three to six months. Lock of treatment can cause port of the scaphoid to deteriorate due to a lack of blood supply, thus preventing healing. Fractures of hand or finger bones ore usually the result of trauma in sports such os martial arts, basketball, and cricket are pain, swelling, and fractured fingers may also be misshapen, sometimes looking twisted.

Treatment involves casting for a hand fracture, with surgical stabilization being needed for some injuries, particularly if the fracture involves a joint or the bone at the base of the thumb fractures may be splinted by a padded aluminum strip, which is anchored to a cast at the wrist.

Ligament Injuries

Sprains to the wrist occur in gymnastics where the hands carry body weight, and as a result of falls or collisions. Finger sprains are common from collisions where the finger is 'knocked back'. The commonest hand injury of all is a sprain of the thumb.

Sprains vary in severity, depending on how many of the ligament fibres are torn. The symptoms of pain and swelling are likely to be greater the more severe the injury. A feeling of weakness in the joint is common but a joint that is lax i.e. can move further than its normal range, suggests a more severe injury.

Initial treatment for all strains is rice. If the injury is not too severe, maintain mobility by keeping the joint moving within the pain-free range. Moderately severe strains should be examined by a manual therapist who will assess function in the joints around the injured joint. A fall onto the outstretched hard could cause problems in the hand, wrist, elbow, shoulder, neck, or upper back.

Severe strains producing laxity in a joint should be seen quickly by an orthopaedic surgeon, as surgical may be needed. More serious problems may include partial dislocation of one of the small bones in the wrist or the degeneration of the cartilage that supports the wrists.

Tendon Injuries

Many of the muscles that move the wrist and hand me in the forearm, so tendons that connect the muscles to bones have to be long, and some hove to get round several corners to allow complex hand movements As a result, there ore few muscle injuries but more tendon injuries. Tendons exposed to high levels of stress or pressure me often protected by a sheath. Excessive levels of stress lead to information of the sheath or teensy like ligaments, tendons can be torn, the Dordogne clanging from a few fibres to a complete rupture.

Mallet Finger An impact, often from a ball, con bend the last joint of a finger forcefully, rupturing the tendon that pulls the finger straight. This results in the person being unable to straighten the finger normally, but they can straighten the finger with their other hand. Occasional the tendon pulls a small piece of bone away, so an X-ray may be useful.

Treatment is in the form of a simple support that fits over the end of the finger, which holds the affected joint into a slightly backward bent position. This the torn ends of the tendon together and allows healing to take place, which is usually complete after about six weeks.

Jersey Finger : This is a rupture of the tendon that bends the lost joint of a finger. It the pull is strong enough to tear the tendon, the person has difficulty bending the joint. Bruising is after visible on the palm side of the finger.

These require prompt professional assessment as the tendon can be pulled into the hand by muscle contraction - this condition necessitates early repair.

Tenosynovitis : Inflammation of a tendon (tendonitis) or its sheath (tenosynovitis) ore injuries resulting from overuse, occurring in sports that place high loads on the wrist and hand such as racket sports, gymnastics, mid rowing. This con include the extended use of rowing machines in health clubs or the home

Symptoms or pain on particular movements, a creaking sensation over the tendon with movement, and tenderness. Which movements produce pain and creaking will depend on which tendon is effected. The commonest site of damage is around the wrist near the thumb.

Prevention is the best treatment, which, as usual, involves thorough worming up, progressive training, and the use of good technique and appropriate equipment or all times. Once injured, a tendon will need rest as continued loading will cause chronic inflammation and the likelihood of fibrosis and adhesions, resulting in a permanent problem

Rest may be accompanied by anti-inflammatory remedies. The correction of any underlying muscle or joint dysfunction is vital for long-term prevention, and in persistent cases steroid injections provide effective relief from symptoms.