Hand and finger dislocations: Difference between revisions
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==Types== | ==Types== | ||
{{Hand and finger dislocation types}} | {{Hand and finger dislocation types}} | ||
==CMC Joint== | ==CMC Joint== | ||
Revision as of 07:24, 1 June 2015
Types
Hand and finger dislocations
- Finger dislocations
- Thumb dislocations
- Hand dislocations
CMC Joint
- Uncommon due to strong ligaments and insertions of wrist flexors/extensors
- Cause is usually result of high-sped mechamisms
- Dislocates usually dorsally and associated w/ fracture(s)
Reduction
- Traction and flexion w/ simultaneous longitudinal pressure on metacarpal base
Management
- Refer to hand surgeon
Thumb
IP Joint
- Uncommon
- Dislocations often associated w/ open injuries
Reduction
- Median nerve block
- Reduce similar to IP joint of other digits
Management
- Immobilization in mild flexion for 3wk is usually all that is required
MCP Joint
- Like other MCP joint dislocations, may be simple or complex
Reduction
- Radial and median nerve blocks
- Pressure directed distally on base of prox phalanx w/ metacarpal flexed and abducted
Management
- Stable reduction: Immobilize in thumb spica w/ MCP joint in 20 deg flexion for 4wk
- Unstable reduction: ORIF
MCP Ulnar Ligament Rupture
- Also known as gamekeeper's thumb or skier's thumb
- Ulnar ligament ruptures at insertion into prox phalanx (due to radial deviation of MCP)
- X-ray (perform before joint stressing)
- Bony avulsion from insertion of UCL into proximal phalanx
- Associated condylar fracture
- Proximal phalanx volar subluxation and radial deviation suggests complete UCL rupture
- Exam
- Swelling and localized tenderness over ulnar border of joint
- Weakness of pinch
- Partial versus complete rupture
- Valgus stress testing with joint in full extension and in 30 deg of flexion
- >35 deg of joint laxity or 15 deg of laxity beyond that present in uninjured thumb is consistent w/ complete UCL rupture
- Valgus stress testing with joint in full extension and in 30 deg of flexion
Management
- Partial rupture
- Immobilize in thumb spica for 4wk
- Full rupture
- Referral within 1wk
Differential Diagnosis
Hand and finger injuries
- Distal finger
- Other finger/thumb
- Boutonniere deformity
- Mallet finger
- Jammed finger
- Jersey finger
- Trigger finger
- Ring avulsion injury
- De Quervain tenosynovitis
- Infiltrative tenosynovitis
- Metacarpophalangeal ulnar ligament rupture (Gamekeeper's thumb)
- Hand
- Wrist
- Drummer's wrist
- Ganglion cyst
- Lunotriquetral ligament instability
- Scaphoid fracture
- Extensor digitorum tenosynovitis
- Compressive neuropathy ("bracelet syndrome")
- Intersection syndrome
- Snapping Extensor Carpi Ulnaris
- Vaughn Jackson syndrome
- General