Orthopaedic Associates-Injury Facts-Hand

Orthopaedic Associates has experts on staff who specialize in hand problems. If you have any questions regarding this or any other topic, please call us at
410-337-7900 or 1-800-678-4671.
You can email us HERE.

de Quervain's Disease

De Quervain's disease is a tenosynovitis (an inflammation of the tendons and their synovial sheaths) involving two of the muscles that help to move the thumb outward from the rest of the hand (abductor policis longus and extensor policis brevis). This injury is especially common in racquet sports and other activities that involve repetitive movements of the hand.

The tendons and their sheaths are contained within a closed space along the radial (thumb) side of the wrist and when inflammation is present pain in the area below the thumb.

Causes:

Chronic, repetitive activities related to sports or a job.
Rapid increases in intensity or frequency of wrist and hand activity. Acute trauma which initiates an inflammatory response.
Pregnancy.
Lifting young children frequently.

Signs/Symptoms:

Pain and tenderness along the radial aspect of the wrist with activity.
Swelling and stiffness along the wrist and/or base of the thumb.
Occasional "click" or "pop" with thumb movement.
Pinch weakness or weak pincer grasp.

Treatment:

Modify activity.
Apply ice for 15 to 20 minutes several times per day.
Treat with anti-inflammatories as prescribed by your physician.
Apply thumb spica splint.
Occasionally, a cortisone shot may be appropriate.

Rehabilitation/Prevention:

Physical therapy for range of motion and strengthening exercises.
Protective taping or bracing of the thumb to restrict excessive motion.
Improve and/or adapt activity techniques.
Warm-up and stretch prior to activity.

CLICK HERE FOR EXERCISES (PDF)
The exercises are in PDF format. To view this file, you need Adobe Acrobat reader. If you don't have access to Adobe acrobat reader, you can go the adobe website and download it for free HERE.

Gamekeeper's Thumb

A sprain of the ulnar collateral ligament of the base of the thumb (metacarpophalangeal joint) is known as a gamekeeper's thumb. This ligament, located on the "finger side" of the first knuckle of the thumb, is responsible for providing stability during pinching and gripping activities. If overlooked or misdiagnosed (e.g. as simply a "sprained thumb") and not cared for properly, this injury can result in persistent instability and significant dysfunction.

Causes:

Acute injury, usually involving an outside force pulling the thumb into abduction (away from the palm), or from a fall the opened hand.
Common injury in skiers.

Signs/Symptoms:

Pain and/or tenderness surrounding the base of the thumb.
Swelling and stiffness of the joint at the base of the thumb.
Inability to pinch objects between the thumb and index finger.

Treatment:

Discontinue activities involving the thumb and/or hand.
Splint or brace the thumb to restrict excessive motion.
Apply ice for 15 to 20 minutes several times per day.
Treat with anti-inflammatories as prescribed by your physician.
Seek orthopaedic evaluation.
Surgical correction may be necessary.

Rehabilitation/Prevention:

Physical therapy for thumb range of motion and strengthening exercises.
Protective taping or bracing to resist forced or excessive abduction.

"Jammed" Fingers

One of the most common injuries in all of sports is the "jammed" finger. This is actually a sprain involving the ligaments or the ligamentous capsules surrounding the various joints of the fingers and is (especially) evident in the interphalangeal joints (knuckles) and the metacarpophalangeal joint (base) of the thumb. These sprains are commonly the result of forced motion at a joint which stresses the supporting ligaments causing varying degrees of damage. This motion is typically lateral (sideways) or hyperextension, damaging the collateral (side) or volar (palm side) ligaments respectively. If the forces involved are powerful enough, a dislocation is possible. Depending on the amount of associated trauma, enduring instabilities can occur and may require medical referral.

Causes:

Acute injury to the finger (e.g. hit by ball, stick, opponent, or ground).
Improper catching technique.

Signs/Symptoms:

Pain and/or tenderness surrounding the involved joint (note: pain in the middle of a bone may indicate a fracture).
Swelling and stiffness surrounding the involved joint.

Treatment:

Modify activity.
Apply ice for 15 to 20 minutes several times per day.
Treat with anti-inflammatories as prescribed by your physician.
"Buddy taping" (i.e. tape the injured digit to an adjacent finger).

Rehabilitation:

Gentle range of motion and strengthening exercises.

Mallet Finger

Finger injuries are common in most sports. Most injuries are minor and can be categorized as either sprains or strains. More serious tendon ruptures or avulsions can mimic these less serious injuries. In the mallet finger, the narrow attachment of the extensor tendon ruptures or avulses (tears away a piece of bone) from the tip of the finger. This injury can result in permanent deformity and dysfunction unless diagnosed and treated correctly.

Causes:

Acute injury, especially a direct blow to the tip of the finger forcing the last knuckle into hyperflexion.
Improper catching technique.

Signs and Symptoms:

Pain and tenderness surrounding the involved joint.
Swelling and stiffness surrounding the involved joint.
Inability to fully extend (straighten) the last knuckle of the finger.

Treatment:

Discontinue activities involving the fingers and/or hand until medically released.
Splint the finger so that the last knuckle is extended.
Apply ice for 10 to 15 minutes by submerging the tip of the finger into a cup of ice water several times per day.
Treat with anti-inflammatories as prescribed by your physician.
Bracing or surgery as recommended by your physician.

Scaphoid (Navicular) Fractures

Many sports-related injuries to the upper extremity involve a fall onto an outstretched arm. The navicular or scaphoid is a small, kidney bean-shaped bone located in the wrist just below the thumb which may be fractured during such a fall. During forced hyperextension (bending the wrist "back"), the scaphoid may become impinged and fracture, typically along the narrow center portion or "waist." Complications arise due to inadequate treatment. The athlete frequently treats the injury as a sprain or bruise. A fracture results in an interruption of the blood supply and, later, bone death or necrosis.

Causes:

Forced hyperextension of the wrist as occurs during a fall onto an outstretched hand.

Signs and Symptoms:

Pain and tenderness on the radial (thumb-side) of the wrist (in the "snuff box").
Swelling and stiffness of the thumb and radial side of the wrist.
Pain when weight-bearing or applying pressure through hand to the wrist (e.g. during "push-ups").

Treatment:

Discontinue activities involving the thumb, hand, and wrist until medically released.
Apply ice for 10 to 15 minutes several times per day.
Treat with anti-inflammatories as prescribed by your physician.
Immobilazation (casting) or surgery as deemed appropriate by your physician.

Rehabilitation/Prevention:

Physical therapy as needed for range of motion and strengthening when prescribed by a physician.
Teach proper falling technique.

Subungual (Nailbed) Hematoma

Direct trauma to the tips of the fingers or toes can cause blood to accumulate (hematoma) under the nail. Blood pooling beneath the fingernail can cause a painful, throbbing pressure that may be exacerbated by any pressure to the fingertip or by movement of the involved finger.

Causes:

Acute injury to the tip of the finger or toe (e.g. hit by ball or stick or "crushing" injury such as being stepped on).

Signs and Symptoms:

Bruising or blackening (ecchymosis) beneath the nail.
Pain which may extend throughout the tip of the finger.
Tenderness throughout the tip of the finger, especially with any pressure to the fingernail.

Treatment:

Apply ice for 10 to 15 minutes by submerging the tip of the finger into a cup of ice water several times per day.
Evacuation of hematoma should be performed by a qualified medical professional.

Rehabilitation/Prevention:

Trim the nails to avoid overhang from the tip of the finger.
Apply a protective pad or splint to the tip of the finger.
Improve/adapt activity techniques.

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