Common Hand Problems in Elite Athletes Fred Corley M.D. Dept. of Orthopaedic Surgery UTHSCSA I have no disclosures concerning this talk. The University of Texas Health Science Center @ San Antonio - Orthopaedics Examination of the athletes hand Tenderness Swelling Loss of motion Loss of sensation Deformity The University of Texas Health Science Center @ San Antonio - Orthopaedics
The University of Texas Health Science Center @ San Antonio - Orthopaedics The University of Texas Health Science Center @ San Antonio - Orthopaedics The University of Texas Health Science Center @ San Antonio - Orthopaedics
The University of Texas Health Science Center @ San Antonio - Orthopaedics The University of Texas Health Science Center @ San Antonio - Orthopaedics The University of Texas Health Science Center @ San Antonio - Orthopaedics
The University of Texas Health Science Center @ San Antonio - Orthopaedics The University of Texas Health Science Center @ San Antonio - Orthopaedics How to recognize them? How to treat them? Pitfalls?
The sprained wrist that isn t Fractured scaphoid Scapho-lunate instability Dislocation of the lunate Fracture of the hook of the hamate Dislocation of the distal radio-ulna joint The missed scaphoid fracture Wrist sprain is an uncommon injury Snuff-box tenderness AP, lat, and oblique x-ray and possible mri Casting and re-evaluate in three weeks
Acute scapho-lunate instability Fall on an outstretched hand Tender over dorsal wrist Limited motion
Dislocation of the lunate Swelling and pain Decreased motion in the digits Possible median nerve symptoms Often missed on x-ray
Fracture of hook of the hamate Found in baseball,tennis,golf Tender over ulnar side of wrist May have ulnar nerve symptoms Carpal tunnel x-ray views Excision of the fragment is the treatment
Isolated dislocation of the distal radio-ulnar joint Wrist locked in full supination or full pronation Severe pain Wrist appears narrow
Condyle fracture of the PIP joint Need oblique x-ray to see fracture Surgery is treatment If neglected arthritis and angulation
THE MALROTATED FINGER FRACTURE PLANE OF NAILS CONVERGENCE OF FINGERS TOWARD SCAPHOID CORRECT EARLY OSTEOTOMY LATE
Dorsal MP dislocation Usually index or thumb Digit is malrotated Sesamoid in joint Requires surgery
Bennett s fracture dislocation of the thumb A fracture-dislocation of the most mobile joint in the hand Needs proper x-rays Not to be confused with fracture of the base of the metacarpal Usually needs surgery
The under-rated fracture dislocation of the fifth carpometacarpal joint Bora s view on x-ray lateral with 30 degree supination If displaced closed reduction and pinning May cause weakness and pain if neglected Fusion if indicated
Acute ulnar collateral ligament injury of the thumb metarcarpophalyngeal joint Difficult to fix if neglected Stress views If complete open repain If partial casting
The missed avulsion of the flexor digitorum profundus Frequently misdiagnosed as a sprain Ring finger is most common Flag football If seen early repair if late can treat with fusion or neglect
Mallet finger Boutonierre deformity Often diagnosed as a sprain Tender over the central slip of the extensor tendon Splint for at least six weeks Can treat as late as three months post injury Rarely requires surgery
Point Tenderness
Volar Plate Rupture Swan neck deformity or rupture of volar plate
Dorsal fracture dislocation of proximal interphalangeal joint Frequently missed Need true lateral x-ray Most can be treated with closed reduction and bracing
The missed human bite infection Initial exam may be deceiving If open needs surgery If unsure elevate,splint and antibiotics for 24 hours Be sure to x-ray
Beware of the proximal interphalangeal joint Fight bite Volar plate injury Boutonierre deformity Fracture dislocation Dislocation Any injury to the pip joint will result in permanent deformity and decreased motion The University of Texas Health Science Center @ San Antonio - Orthopaedics Take a good history Adequate physical exam Appropriate radiographs Don t fall in the pit!!!!!!!