HAND | WRIST | THUMB

a. Acute wrist

i. Fracture

  1. Distal radius/ ulna
  2. Scaphoid
  3. Hook of hamate

ii. Dislocation

  1. Capral bones
  2. Scapholunate

b. Fractures (hand)

i. Metacarpals

ii. Phalanges

iii. MTP joints


c. Ligament & tendon injuries

i. UCL/ RCL

ii. PIP joint sprain

iii. Mallet finger

iv. Boutonniere deformity

v. Avulsion of the flexor digitorum profundus tendon

vi.

Your diagnosis is: TFCC injury

  • Pain arising from the cartilage complex of the ulnar (pinky finger) side of the wrist

It presents like this:

  • A fall onto the wrist with an outstretched hand
  • Increasing discomfort in response to repetitive tasks involving compression or traction of the wrist such as weightlifting or racket sports

It feels like this at rest:

  • Often only a dull ache or no pain at all with complete rest in the early stages of overuse injury to the TFCC
  • Activities like turning a key, using a can opener or lifting heavy pans often increases the pain
  • Weakness and instability of the wrist are often reported

 

We look for this in assessment:

  • Tenderness on palpation around the ulnar side of the wrist
  • Reduction in grip strength
  • A positive TFCC stress test or pain with resisted lift off increase suspicion

We initially manage TFCC injury by:

  • Referral for an MRI in more severe instances – the most sensitive scan for diagnosing TFCC injury
  • Fitting of a brace to prevent aggravation
    • Wrist widget in minor cases – usually for lower grade degenerative injuries
    • Full wrist brace for more severe injuries
  • Firm releases of the wrist musculature can help to take pressure of the TFCC and reduce acute symptoms

Longer term management strategies to aid performance and prevention include:

  • Specific strengthening programs aimed at improving wrist control and load tolerance, especially in positions of compression (such as push ups)
  • Analysis of biomechanics and lifting techniques (including gym programs) to help manage risk factors for recurrence
  • Referral to an orthopaedic hand specialist may be required for complex injuries

vii.

Trigger Finger

Trigger finger is characterised by inflammation and narrowing of the flexor tendon sheath in which the flexor tendons glide through to allow bending and straighten (flexion/ extension) of the fingers.  Trigger finger may affect anyone; however middle-aged women and diabetics are more likely to develop the condition.   A history of prolonged finger flexion will often be reported (prolonged writing, grasping, computer work, carrying bags etc.).   Initially patients present with a painless clicking when moving their finger, with occasionally painful catching.  Loss of range of motion and swelling may be present.   A palpable thickening may also be experienced.

You can expect to feel stiffness and symptoms worse in the morning.  Movement typical becomes more restricted with time.  Waking at night with the finger bent may also occur.  There may be some referred symptoms into the hand or forearm on the palmar surface.

We initially manage trigger finger by implementing gentle hands on manual therapy including soft tissue release, IASTM ‘tools’, mobilisation, ice/heat and splinting.  Activity medication is important; stopping activities which aggravate the condition is important.

Longer term we look to strengthen the hand and forearm, re-introduce or increase previous activity and address any mechanical dysfunctions that may have led to the development of the condition.