2/28/2024 0 Comments Acute oblique fracturePassive manipulation of the joint in flexion and extension as well as lateral deviation should be performed after active motion is assessed. Loss of active motion but full passive motion can be indicative of tendon injury for instance, an extensor lag may indicate damage to the extensor tendon. The degree of instability and the angle at which the instability occurs should be noted and used to help determine the specific anatomic site of injury. It is important to assess the motion of the joint while the patient voluntarily flexes and extends it. ![]() A two-stage functional assessment of the joint should be performed, using a digital or wrist block if motion is limited by pain ( Fig. Occasionally, further imaging using CT or MRI may be required to completely assess intra-articular pathoanatomy. Posteroanterior (PA) and lateral radiographic views of the affected finger are mandatory, and oblique views may be of additional benefit in judging the extent of articular injuries. Palpation should be performed in a standard fashion, utilizing the examiner’s knowledge of the appropriate anatomy to discern patterns of injury.Ī radiographic evaluation should be performed prior to assessing range of motion (ROM) and stability in order to exclude obviously unstable or severe injuries. Observation for symmetrical or asymmetrical edema (consistent with unilateral collateral ligament injury), ecchymosis, and deformity is a critical first step. The primary goal of the physical exam is to assess the stability of the injured joint. Based on a thorough diagnostic evaluation and individualized treatment plan created to address the injuries identified, clinicians may maximize patient recovery and satisfaction and speed return to vocational and recreational activities.Īfter an injury occurs, a thorough history of the injury should be obtained from the patient, including mechanism, finger position during injury, the presence of deformity, previous treatments received, and a subjective sense of stability. Swanson stated in his landmark article: “Hand fractures can be complicated by deformity from no treatment, stiffness from overtreatment, and both deformity and stiffness from poor treatment.” The precise balance of proper surgical and therapeutic techniques is critical. The treating physician’s and therapist’s goal is to balance the joint immobilization required for healing with mobilization necessary to prevent stiffness and pain. ![]() Soft tissue injuries and dislocations are common injuries as well. The phalanges and metacarpals account for 10% of all fractures referred to hand surgeons. The incidence of injury peaks during youth and young adulthood due to participation in athletics and industrial vocations. The vital usefulness of the hand in so many activities thereby renders it susceptible to trauma, and it is therefore the most commonly injured part of the upper extremity. The activities of daily living require that our hands have stability and motion at numerous joints. ![]() The numerous ways and circumstances in which humans can position their hands places the hand and finger joints at risk for injury.Ī thorough knowledge of the articular and ligamentous anatomy is paramount to providing the best treatment for each patient.Ī good working relationship with the therapist providing care is critical in returning patients back to their vocational and recreational activities with the goal of having a painless and functional extremity.
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