Metacarpals

• Palpated in orderPalpated in order

• Numbered 1 -5 Numbered 1 -5

• Starting at thumbStarting at thumb

• Palpate the entire lengthPalpate the entire length

1st Metacarpal• From Snuffbox to MCP JointFrom Snuffbox to MCP Joint• Shorter and broader than other metacarpalsShorter and broader than other metacarpals

Trapezium

1st Metacarpal

– EtiologyEtiology• Direct axial force or Direct axial force or • Compressive forceCompressive force• 5th metatarsal5th metatarsal

– Boxing or martial arts Boxing or martial arts – (boxer’s fracture)(boxer’s fracture)

– Signs and SymptomsSigns and Symptoms• Pain Pain • SwellingSwelling• CrepitusCrepitus• Possible deformityPossible deformity

– angular angular – rotationalrotational

Metacarpal Fracture

– Fracture testsFracture tests• PalpationPalpation• CompressionCompression• Axial compressionAxial compression• PercussionPercussion

– ManagementManagement• RICERICE• Analgesics Analgesics • X-ray examinationX-ray examination• Deformity is reducedDeformity is reduced• SplintingSplinting

– 30 degrees of flexion 30 degrees of flexion – 4 weeks 4 weeks

• EtiologyEtiology

– Direct traumaDirect trauma

– Twist Twist

• Signs and Signs and SymptomsSymptoms

– PainPain

– SwellingSwelling

– DeformityDeformity

– CrepitusCrepitus

Phalangeal Fractures

• ManagementManagement– RICE RICE – Proximal FractureProximal Fracture

• Splint Splint

• Buddy tapingBuddy taping

– Middle FractureMiddle Fracture• No deformity No deformity

– Buddy tape w/ thermoplastic splint for activityBuddy tape w/ thermoplastic splint for activity

• Deformity Deformity – Immobilization for 3-4 weeks Immobilization for 3-4 weeks – Protective splint for an additional 9-10 weeks during Protective splint for an additional 9-10 weeks during

activityactivity

Proximal FractureProximal Fracture Middle FractureMiddle Fracture

Distal Phalangeal Fracture

• EtiologyEtiology– Crushing forceCrushing force

• Signs and SymptomsSigns and Symptoms– Pain Pain – SwellingSwelling– CrepitusCrepitus– Subungual hematomaSubungual hematoma

• ManagementManagement– RICE RICE – Protective splint Protective splint

• 0º flexion0º flexion

Joints• Metacarpophalangeal JointMetacarpophalangeal Joint

• Proximal Interphalangeal Joint Proximal Interphalangeal Joint

– (PIP Jt.)(PIP Jt.)

• Distal Interphalangeal Joint Distal Interphalangeal Joint

– (DIP Jt.)(DIP Jt.)

• Interphalangeal Joint Interphalangeal Joint

– Thumb (IP)Thumb (IP)

IP Joint Anatomy

Volar Plate

Collateral Ligament

Volar Plate

Collateral Ligament

Accessory Ligament

Checkrein Ligament

Accessory Ligament

Middle Phalange

Proximal Phalange

Proximal

Distal

Middle Phalange

• EtiologyEtiology

– Fingers are prone to sprains Fingers are prone to sprains

– Direct blows or twistingDirect blows or twisting

– Occurs w/ axial loading orOccurs w/ axial loading or

– Valgus/varus stresses Valgus/varus stresses

– Similar to fractures and dislocationsSimilar to fractures and dislocations

– Injury can damage Injury can damage

• Collateral ligamentsCollateral ligaments

• Volar plateVolar plate

IP Joint Sprains• Special TestsSpecial Tests

– Fracture testsFracture tests

– Radial and Ulnar deviationRadial and Ulnar deviation

• Assess collateral ligamentsAssess collateral ligaments

– Anterior and posterior glide testsAnterior and posterior glide tests

• Assess joint capsuleAssess joint capsule

Interphalangeal Joint Sprains

Volar Plate

Collateral Ligament

• ManagementManagement– RICERICE– X-ray examination X-ray examination – PIP sprainPIP sprain

• 30 - 40º flexion30 - 40º flexion

• 10 days10 days

– DIP SprainDIP Sprain• Splint for a few daysSplint for a few days

• Full extension Full extension

• TapingTaping

Metacarpophalangeal JointsMetacarpophalangeal Joints

Head of 2nd Metarsal

(MC-P Joints)(MC-P Joints)

• AssessmentAssessment– Place joint in full flexionPlace joint in full flexion

– Radial deviationRadial deviation

– Ulnar deviationUlnar deviation

– RotationRotation

• PalpationPalpation– Place joint in flexionPlace joint in flexion

– Joint exposed betterJoint exposed better

– Groove for extensor tendonGroove for extensor tendon

– EtiologyEtiology• Hyperextension Dorsal PIPHyperextension Dorsal PIP

• Axial load on a partially flexed DIP jointAxial load on a partially flexed DIP joint

PIP and DIP Dislocations

– Signs and SymptomsSigns and Symptoms• Obvious deformityObvious deformity• Swelling Swelling • Possible avulsion volar platePossible avulsion volar plate• Possible fracturePossible fracture

– ManagementManagement

• RICERICE

• Reduction by MDReduction by MD

• Post reduction splinting Post reduction splinting

• Buddy tapingBuddy taping

• Begin motion at 3 weeksBegin motion at 3 weeks

• Large bone fragments splint 30-60º Large bone fragments splint 30-60º flexionflexion

• Small bone fragments buddy tapingSmall bone fragments buddy taping

– EtiologyEtiology• Caused by a blow that contacts tip of finger Caused by a blow that contacts tip of finger

Mallet Finger (baseball or basketball finger)Mallet Finger (baseball or basketball finger)

– EtiologyEtiology• DIP joint injuryDIP joint injury

• Rupture of flexor muscleRupture of flexor muscle

• Common injury to football linemanCommon injury to football lineman

Jersey Finger

Subungual Hematoma

•Bruising bleeding under fingernailBruising bleeding under fingernail

•Extremely painful due to build-up of pressure under nailExtremely painful due to build-up of pressure under nail

–Pressure must be released once hemorrhaging has ceasedPressure must be released once hemorrhaging has ceased

–Release as distally as possibleRelease as distally as possible

–Bandage with antibiotic ointmentBandage with antibiotic ointment

–Hot paper clipHot paper clip

–Finger nail drillFinger nail drill

–ScalpelScalpel