Hand and Wrist Injuries Uniformed Services University …手和手腕受伤的统一服务大学….ppt

Hand and Wrist Injuries Allyson S. Howe, MD January 17, 2008 HAND AND WRIST HAND WRIST HAND FUNCTIONS 45% GRASP 45% PINCH Side pinch (key pinch) Tip pinch (writing) Chuck pinch (thumb to index/ring) 5% HOOK Carry bag 5% PAPERWEIGHT HAND FINGER ANATOMY 9 Finger Flexors Median nerve Transverse carpal ligament 5 deep flexors pass through superficialis tendons and insert on distal phalanx of each finger and thumb 4 superficial flexors insert on middle phalanx of digits 2-5 Annular ligaments = pulleys (A1-A5) PREVENT BOWSTRINGING HAND ANATOMY VOLAR PLATE Thickened portion of joint capsule Static stabilizer (hyperextension) COLLATERAL LIGAMENTS Medial and lateral stability Maximally tight at ____ degrees MCP flexion ____ degrees PIP flexion ____ degrees DIP flexion HAND ANATOMYdigits FLEXOR FDP FDS Volar plate Extensor Central bands Lateral bands NERVES OF THE HAND RADIAL MEDIAN ULNAR WRIST AND FINGER EXTENSION THENAR COMPARTMENT, OPPOSITION, PINCER GRIP INTRINSIC MUSCLES POWER GRIP MALLET FINGER ANATOMY Dorsal avulsion Extensor digitorum tendon tear MECHANISM: Forced flexion of extended digit TREATMENT: No fracture: DIP extended for 6-8 weeks FRACTURE: if 30% joint surface, splint x 4 weeks If 30%? refer for ORIF Less than full passive extension? refer COMPLICATIONS: Pressure necrosis from splint Permanent extensor lag MALLET FINGER JERSEY FINGER JERSEY FINGER ANATOMY: Tendon retracts Avulsion fragment may limit retraction Blood supply compromised MECHANISM: Forced extension of flexed finger TREATMENT: Refer immediately COMPLICATIONS: Permanent loss of flexion JERSEY FINGER EXAM FINDINGS: Unable to flex isolated DIP Localized tenderness along flexor tendon FDP: hold PIP straight and flex DIP FDS: hold MCP straight and flex PIP or hold all fingers in extension except affected and flex VOLAR PLATE RUPTURE EXAM FINDINGS: Tender volar PIP Bruising, swelling MECHANISM: Hyperextension injury Ruptures distally from attachment at middle p