8977 Lecture Notes - Lecture 8: Ulnar Nerve, Metacarpal Bones, Subungual Hematoma
3 Jul 2018
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FINGER INJURIES
Common/ Less Likely/ NTBM?
Objective Examination
Observe and compare right to left skin, swelling and deformities (nodules/tendon disruption)
Sx: FDP/FDS tendon injury, volar plate grade 3, central slip injury or particular fractures (proximal phalanx, angulated or dorsal
PIP dislocation). Dorsal dislocations are more common
Articular/Muscular tests (Load tissue of interest to reproduce symptoms)
AROM – DIP flexion, PIP flexion, thumb web (measure onto paper). Measure with goni or creases on hand reached.
PROM (only if restricted AROM) – all same as AROM and overpressure if needed.
Resisted – FDS, FDP and Elson’s test (“gay” – if flexion occurs injury to extensor mechanism or extensor hood has occurred).
Neurological tests – if pins and needles. Test with a tissue using long strokes down finger.
Vascular tests – put pressure on nail and all the way up the finger
Palpation – proximal to distal, dorsal then volar. Palpate DIP, PIP, MCP, volar plate, extensor hood, collateral ligs.
X-ray – if fracture suspected (or FDP/FDS tendon injury, volar plate grade 3, central slip injury) x-ray before special tests
Special tests
Collateral ligaments – palm down (0 degrees accessory and 30 degrees true)
Elson’s test for extensor mechanism (central slip damage)
Finkelsteins (De Quervains ) – thumb in palm and wrap up fingers, pull hand down.
Volar plate – over pressure hyperextension
FDS – to test PIP injury
FDP – to test DIP injury
Functional tests
Open and close fist, lumbricals sweep, oppose each finger
Diagnosis
Rule out less likely and NTBM. Rationalise why you have come to your conclusions.
Intervention (treatment for today and in future)
Acute phase
Support/ Protect/ Maintain:
Taping for stability and support: (collaterals) Thumb stability taping and buddy taping – wrap around phalanx.
Volar plate grade 1 hold in slight flexion, refer grade 2+3 on. Avoid extension
Collaterals – heal in straight position. Avoid scissoring
Central slip – avoid PIPJ flexion, allow DIPJ flexion.
Skiier’s thumb – splint in slight flexion
Thermoplastic splinting
Manage pain and inflammation with Coban tape, RICE and EPAs
Subacute phase:
Regain ROM: AVOID ADHESION. PPM, stretching (using tape/bands), spring brace. PAM for increase in range or stiffness
(thumb only)
Regain Control: tendon glides are necessary during healing both flexor and extensor tendons. Pick up items, roll
something into a ball between fingers, etc.
Regain Strength: can use putty for flexion (and extension) or bands around fingers for extension
Regain Function: regain ADLs (writing, tying shoe lacers, typing) and dynamometer will measure grip strength. Can
measure pincer grip (pinch), tripod grip (pen) and key grip.
COMMON LESS LIKELY NOT TO BE MISSED
HAND + FINGER PAIN
Metacarpal fracture Bennett’s fracture (1st CMCJ fracture) Potential infection
Phalanx fracture Dislocation of MCP joint Avulsion of long flexor tendons (jersey finger)
Dislocation + sprain of PIP joint Dislocation + sprain of DIP joint
Ulnar collateral lig sprain/tear “skier’s thumb” Radial collateral lig sprain Swan neck (chronic mallet)
Laceration Mallet finger (ext tendon avulsion) Boutonniere deformity (central slip complication)
Infections Stress fractures
find more resources at oneclass.com
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Document Summary
Observe and compare right to left skin, swelling and deformities (nodules/tendon disruption) Sx: fdp/fds tendon injury, volar plate grade 3, central slip injury or particular fractures (proximal phalanx, angulated or dorsal. Articular/muscular tests (load tissue of interest to reproduce symptoms) Arom dip flexion, pip flexion, thumb web (measure onto paper). Measure with goni or creases on hand reached. Prom (only if restricted arom) all same as arom and overpressure if needed. Resisted fds, fdp and elson"s test ( gay if flexion occurs injury to extensor mechanism or extensor hood has occurred). Test with a tissue using long strokes down finger. Vascular tests put pressure on nail and all the way up the finger. Palpation proximal to distal, dorsal then volar. Palpate dip, pip, mcp, volar plate, extensor hood, collateral ligs. X-ray if fracture suspected (or fdp/fds tendon injury, volar plate grade 3, central slip injury) x-ray before special tests. Collateral ligaments palm down (0 degrees accessory and 30 degrees true)
