Hand Fracture Hand fracture means the injury, dislocation, fracture, or breaks of the bone of the hand with injury of tendon, cartilage, ligament, and soft tissue laceration. You may have difficulty using your hands or wrist along with numbness and tingling in the fingers. There may be a pain as you try to move your fingers, especially when trying to grip an object. Bruising is also a very common symptom associated with wrist fractures. Hand injuries come about for various reasons, including work, trauma, overuse, or sports. The three most common hand injuries are fractures/avulsions, tendinitis, and dislocations/deformities. Anatomy of Hand Muscles Muscles that act at the Wrist Extensor Carpi Radialis Longus Extensor Carpi Radialis Brevis Extensor Carpi Ulnaris Flexor Carpi Radialis Flexor Carpi Ulnaris Palmaris Longus Extrinsic hand muscles act on the wrist and the digits Extrinsic Hand Muscles Extensor Digitorum Extensor Indicis Extensor Digiti Minimi Flexor Digitorum Superficialis Flexor Digitorum Profundus Extrinsic Thumb Muscles Flexor Pollicis Longus Extensor Pollicis Longus Extensor Pollicis Brevis Abductor Pollicis Longus Abductor Pollicis Brevis Intrinsic Hand Muscles Thenar Muscles Abductor Pollicis Brevis Flexor Pollicis Brevis Opponens Pollicis Adductor Pollicis Hypothenar Muscles Opponens Digiti Minimi Flexor Digiti Minimi brevis Abductor Digiti Minimi Lumbricals Dorsal Interossei Palmar Interossei Bones Radius Ulna Scaphoid Lunate Triquetrum Pisiform Trapezium Trapezoid Capitate Hamate Metacarpals Phalanges (Hand) Proximal Phalanx (Hand) Middle Phalanx (Hand) Distal Phalanx (Hand) Joints Distal Radioulnar Joint (Wrist) Intercarpal Joint Carpometacarpal Joint Metacarpophalangeal Joint Proximal Interphalangeal Joint (Hand) Distal Interphalangeal Joint (Hand) Ulnocarpal Joint Ligaments Triangular Fibrocartilage Complex (TFCC) Scapholunate Ligament Lunotriquetral Ligament Capitolunate Ligament Radiotriquetral Ligament Ulnar Collateral Ligament (Thumb) Transverse Carpal Ligament Pisohamate Ligament Volar Carpal Ligament Nerves Ulnar Nerve Median Nerve Anterior Interosseus Nerve Radial Nerve Posterior Interosseus Nerve Vascular Supply Needs to be updated Other Anatomic Structures Carpal Tunnel Guyons Canal Volar Plate Extensor Tendon Compartments Nail Bed Anatomy Injury and Fracture of hand Fractures Phalanx Fractures (Hand) Metacarpal Fractures Boxer’s Fracture Rolando Fracture Bennett Fracture Dislocations Metacarpophalangeal Joint Dislocation Proximal Interphalangeal Joint Dislocation Distal Interphalangeal Joint Dislocation Carpometacarpal Joint Dislocation Tendinopathies Extensor Tendon Injuries (Hand) Central Slip Extensor Tendon Injury Flexor Tendon Injuries (Hand) Boutonniere Deformity Swan Neck Deformity Jersey Finger Mallet Finger Trigger Finger De Quervains Tenosynovitis Ligament Injuries Gamekeepers Thumb (UCL) Radial Collateral Ligament of the Thumb Injury (RCL) Volar Plate Avulsion Injury Neuropathies Wartenberg’s Syndrome Carpal Tunnel Syndrome Guyon Canal Syndrome Arthropathies Carpometacarpal Arthritis Finger Arthritis Rheumatoid Arthritis Nail Bed Injuries Nail Bed Lacerations Nail Bed Avulsions Subungual Hematoma Paronychia Felon Pediatric Considerations Proximal Phalanx Avulsion Fracture (Thumb) Middle and Distal Phalanx Avulsion Fracture Other Dupuytrens Contracture Symptoms A broken hand might cause these signs and symptoms: Severe swelling, or bruising over the top of the bone, numbness or tingling. A “cracking” (not “popping”) sound at the time of the injury. The area looks lopsided or “deformed,” or the bone is poking through Severe pain that might worsen when gripping or squeezing or moving your hand. Swelling. Tenderness. Bruising. Obvious deformity, such as a crooked finger. Stiffness or inability to move your fingers or thumb. Numbness in your hand or fingers. Hand pain and tenderness to touch (over the back of the hand or palm) Hand swelling. Hand bruising. Hand pain / grinding when making a fist. Hand deformity (fingers may not line up normally when making a fist) Diagnosis Physical examination of the Hand Follows the IP-PASS examination methodology Inspection Palpation Passive Range of Motion Active Range of Motion Strength & Neurovascular Special Tests Inspection Skin Color: erythema, ecchymosis, pallor, black Trophic changes (altered hair growth, sweat production) Scars Swelling Muscle tone Thenar atrophy: Median Nerve injury Interosseus atrophy: Ulnar Nerve Injury Deformity Asymmetry Radial or ulnar deviation Rotation Amputation Arthritic nodes Boutonniere Swan Neck Angulation: Cascade Sign Palpation Joint Effusion Clicking Snapping Crepitus Tenderness Temperature Masses Range of Motion Finger MCP: 0° – 85° PIP: 0° – 110° DIP: 0° – 65° Wrist Flexion: 60° Extension: 60° Radioulnar Deviation: 50° Strength and Neurovascular Sensation Recommend: 2 point discrimination (use paper clip) Light touch Motor: Median Nerve: “A-OK” sign: flexion of thumb and index finger or thumb and pinky against resistance Ulnar Nerve: Test fingers against resistance in abduction Radial Nerve: Test thumb extension against resistance Vascular Radial pulse Ulnar pulse Allen’s Test Special Tests De Quervains Tenosynovitis Finkelstein’s Test Eichhoff’s Test Central Slip Extensor Tendon Injury Elson’s Test Gamekeeper’s Thumb UCL Stress Test (Thumb) TFCC Injury TFCC Shear Test TFCC Stress Test Wartenbergs Syndrome Tinel’s Test Finkelstein’s Test Carpal Tunnel Syndrome Tinels Test Phalens Test Durkans Test Scapholunate Instability Scaphoid Shift Test Lunotriquetral Instability Reagans Test Kleinmans Shear Test Distal Radial Ulnar Joint Instability Piano Key Test Carpometacarpal Arthritis Thumb CMC Grind Test