Kin 191 B – Wrist, Hand And Finger Evaluation And Pathologies

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Kin 191 B – Wrist, Hand And Finger Evaluation And Pathologies

  1. 1. KIN 191B – Advanced Assessment of Upper Extremity Injuries Wrist, Hand and Finger Evaluation and Pathologies
  2. 2. History
  3. 3. History <ul><li>Location of pain </li></ul><ul><li>Mechanism of injury/etiology </li></ul><ul><li>Unusual sounds/sensations </li></ul><ul><li>Onset/duration and description of symptoms </li></ul><ul><li>Prior history/general health concerns </li></ul>
  4. 4. Location of Pain <ul><li>Generally, local injury represented by local symptoms – sometimes difficult to identify specific structure/s </li></ul><ul><li>Must be aware of possible referred pain from cervical, shoulder and/or elbow pathologies </li></ul>
  5. 5. Mechanism of Injury <ul><li>Direct trauma </li></ul><ul><li>Hyperextension/hyperflexion injuries of wrist and/or fingers </li></ul><ul><li>Insiduous onset increases likelihood of chronic conditions </li></ul><ul><li>Identify factors which increase or decrease symptoms </li></ul>
  6. 6. Unusual Sounds or Sensations <ul><li>Numbness/tingling indicative of neurological pathology – must establish if local or referred </li></ul><ul><li>Fractures, dislocations and tendon ruptures often accompanied by “popping” sensation </li></ul><ul><li>Some overuse conditions (tendonitis) may present with “snapping” sensation </li></ul>
  7. 7. Onset/Duration and Description of Symptoms <ul><li>Type of pain (ache, throb, etc.) </li></ul><ul><li>Intensity of pain (objectify) </li></ul><ul><li>Immediate vs. gradual onset of symptoms </li></ul><ul><li>Changes in symptoms (better, worse) </li></ul>
  8. 8. Prior History and General Health Concerns <ul><li>Any previous injury, especially if neurological in nature, may have lasting effect on function, etc. </li></ul><ul><li>Hand is typically first part of body to be affected by: </li></ul><ul><ul><li>Arthritis </li></ul></ul><ul><ul><li>Peripheral vascular disease (PVD) </li></ul></ul><ul><ul><ul><li>Insufficient vascular structures to provide adequate circulation </li></ul></ul></ul><ul><ul><li>Raynaud’s phenomenon </li></ul></ul><ul><ul><ul><li>Reaction to cold temps – alternating bouts of pallor and cyanosis (vascular responses) </li></ul></ul></ul>
  9. 9. Inspection/Observation
  10. 10. Inspection/Observation <ul><li>General inspection </li></ul><ul><li>Inspection of wrist and hand </li></ul><ul><li>Inspection of thumb and fingers </li></ul>
  11. 11. General Inspection <ul><li>Hand posture </li></ul><ul><ul><li>Relaxed normal hand is slightly flexed with subtle palmar arch </li></ul></ul><ul><li>Gross deformity </li></ul><ul><ul><li>Associated with fractures and/or dislocations </li></ul></ul><ul><li>Palmar creases </li></ul><ul><ul><li>May not be visible if severe swelling </li></ul></ul><ul><li>Cuts, scars, lacerations </li></ul><ul><ul><li>Superficial nature of neurovascular structures makes them susceptible to injury even with superficial wounds </li></ul></ul>
  12. 12. Inspection of Wrist and Hand <ul><li>Distal radioulnar continuity </li></ul><ul><li>Carpal and metacarpal continuity/contour </li></ul><ul><li>MP joint alignment </li></ul><ul><ul><li>Depressed knuckle = Boxer’s fracture </li></ul></ul><ul><li>Wrist and hand posturing </li></ul><ul><ul><li>Neurovascular conditions may prompt abnormalities (drop wrist, Volkmann’s ischemic contracture) </li></ul></ul>
  13. 13. Inspection of Wrist and Hand <ul><li>Ganglion cyst </li></ul><ul><ul><li>Defined as benign collection of thick fluid within a tendinous sheath or joint capsule </li></ul></ul><ul><ul><li>Most commonly found in wrist and hand </li></ul></ul><ul><ul><li>Painful with motions that impinge upon when symptomatic </li></ul></ul>
  14. 14. Inspection of Thumb and Fingers <ul><li>Skin and fingernails </li></ul><ul><ul><li>Subungual hematoma </li></ul></ul><ul><ul><li>Paronychia – infection at nail periphery </li></ul></ul><ul><ul><li>Felon – infection/abscess at or distal to DIP </li></ul></ul><ul><li>Finger alignment and deformity </li></ul><ul><ul><li>If finger out of alignment, may be spiral fracture of phalanx/metacarpal </li></ul></ul><ul><ul><li>Secondary to fracture, dislocation or tendon injury </li></ul></ul>
  15. 15. Skin and Fingernail Conditions
  16. 16. Palpation
  17. 17. Palpation <ul><li>Wrist and finger flexors </li></ul><ul><li>Wrist and finger extensors </li></ul><ul><li>Bony anatomy </li></ul><ul><ul><li>Non-carpal bones </li></ul></ul><ul><ul><li>Carpal bones </li></ul></ul><ul><li>Ligamentous and intrinsic muscular structures </li></ul>
  18. 18. Wrist and Finger Flexors <ul><li>Flexor carpi ulnaris tendon </li></ul><ul><li>Flexor carpi radialis tendon </li></ul><ul><li>Tendons of finger flexors </li></ul><ul><ul><li>Superficialis vs. profundus </li></ul></ul><ul><li>Palmaris longus tendon </li></ul>
  19. 19. Wrist and Finger Extensors <ul><li>Extensor digitorum tendons </li></ul><ul><li>Anatomical snuffbox </li></ul><ul><ul><li>Extensor pollicis longus – medial (ulnar) border </li></ul></ul><ul><ul><li>Abductor pollicis longus and extensor pollicis brevis – lateral (radial) border </li></ul></ul><ul><ul><li>Scaphoid - floor </li></ul></ul>
  20. 20. Anatomic Snuffbox
  21. 21. Non-Carpal Bony Anatomy <ul><li>Distal radius/radial styloid process </li></ul><ul><li>Lister’s tubercle (dorsal and distal radius) </li></ul><ul><li>Ulnar head/ulnar styloid process </li></ul><ul><li>Metacarpals </li></ul><ul><li>Phalanges </li></ul>
  22. 22. Carpal Bony Anatomy <ul><li>Scaphoid </li></ul><ul><ul><li>Floor of snuffbox, easier with ulnar deviation </li></ul></ul><ul><li>Lunate </li></ul><ul><ul><li>Typically aligned with 3 rd metacarpal, distal to Lister’s tubercle and flex wrist </li></ul></ul><ul><li>Triquetrum </li></ul><ul><ul><li>Just distal to ulnar styloid process </li></ul></ul><ul><li>Pisiform </li></ul><ul><ul><li>Small, rounded prominence at proximal aspect of hypothenar eminence in palm </li></ul></ul>
  23. 23. Carpal Bony Anatomy <ul><li>Trapezium </li></ul><ul><ul><li>Between scaphoid and 1 st metacarpal </li></ul></ul><ul><li>Trapezoid </li></ul><ul><ul><li>Base of 2 nd metacarpal </li></ul></ul><ul><li>Capitate </li></ul><ul><ul><li>Move toward thumb from hamate, base of 3 rd metacarpal </li></ul></ul><ul><li>Hamate </li></ul><ul><ul><li>“ hook” of hamate is large prominence at proximal hypothenar eminence on palm </li></ul></ul>
  24. 24. Ligamentous and Intrinsic Muscular Anatomy <ul><li>Radial collateral ligaments </li></ul><ul><ul><li>Radiocarpal joint, MP/IP/PIP/DIP joints </li></ul></ul><ul><li>Ulnar collateral ligaments </li></ul><ul><ul><li>Ulnocarpal joint, MP/IP/PIP/DIP joints </li></ul></ul><ul><li>Carpal tunnel (transverse carpal ligament) </li></ul><ul><li>Thenar eminence </li></ul><ul><li>Hypothenar eminence </li></ul>
  25. 25. Range of Motion
  26. 26. Range of Motion <ul><li>Active/passive/resistive </li></ul><ul><ul><li>Wrist </li></ul></ul><ul><ul><ul><li>Flexion/extension, ulnar/radial deviation </li></ul></ul></ul><ul><ul><li>Thumb (carpometacarpal joint) </li></ul></ul><ul><ul><ul><li>Flexion/extension, abduction/adduction, opposition </li></ul></ul></ul><ul><ul><li>Fingers </li></ul></ul><ul><ul><ul><li>MP joints: flexion/extension, abduction/adduction </li></ul></ul></ul><ul><ul><ul><li>IP/PIP/DIP joints: flexion/extension </li></ul></ul></ul>
  27. 27. Wrist Ranges of Motion <ul><li>Flexion – normally 80-90 degrees, firm end feel </li></ul><ul><li>Extension – normally 75-85 degrees, firm end feel </li></ul><ul><li>Radial deviation – normally 20 degrees, hard end feel (scaphoid on radial styloid) </li></ul><ul><li>Ulnar deviation – normally 35 degrees, firm end feel </li></ul>
  28. 28. Wrist Ranges of Motion
  29. 29. Thumb Ranges of Motion <ul><li>Flexion – normally 60-70 degrees, soft end feel </li></ul><ul><li>Extension – 0 degrees, firm end feel </li></ul><ul><li>Abduction – 70-80 degrees, firm end feel </li></ul><ul><li>Adduction – 0 degrees, soft end feel </li></ul><ul><li>Opposition – flexion/adduction/rotation, touch thumb to little finger, firm end feel </li></ul>
  30. 30. Thumb Motions
  31. 31. Finger Ranges of Motion <ul><li>MP joints </li></ul><ul><ul><li>Flexion – 85-105 degrees, hard end feel (proximal phalanges on distal metacarpal) </li></ul></ul><ul><ul><li>Extension – 20-30 degrees, firm end feel </li></ul></ul><ul><ul><li>Abduction/adduction – total of 20-25 degrees, firm end feel </li></ul></ul><ul><li>IP/PIP/DIP joints </li></ul><ul><ul><li>Flexion – IP: 80-90 degrees, PIP: 110-120 degrees, DIP: 80-90 degrees, firm end feels except PIP is hard end feel (middle phalanges on proximal phalanges) </li></ul></ul><ul><ul><li>Extension – 0 degrees, firm end feels </li></ul></ul>
  32. 32. Ligamentous/Capsular Testing
  33. 33. Ligamentous/Capsular Testing <ul><li>Carpal glide tests </li></ul><ul><ul><li>Attempts to elicit abnormal glide of carpal bones </li></ul></ul><ul><li>Varus/valgus stress tests (do at multiple joint positions) </li></ul><ul><ul><li>Wrist </li></ul></ul><ul><ul><ul><li>UCL limits radial deviation and flexion/extension </li></ul></ul></ul><ul><ul><ul><li>RCL limits ulnar deviation and flexion/extension </li></ul></ul></ul><ul><ul><ul><li>Can also assess with glide between radius/ulna and proximal row of carpal bones </li></ul></ul></ul><ul><ul><li>MP/IP/PIP/DIP joints </li></ul></ul><ul><ul><ul><li>Thumb UCL is common injury site </li></ul></ul></ul>
  34. 34. Neurovascular Evaluation
  35. 35. Neurological Evaluation <ul><li>Peripheral nerve distributions </li></ul><ul><ul><li>Median, ulnar and radial nerve sensory and motor functions </li></ul></ul><ul><li>Nerve root level distributions </li></ul><ul><ul><li>Dermatomes and myotomes </li></ul></ul>
  36. 36. Vascular Evaluation <ul><li>Radial artery </li></ul><ul><li>Capillary refill </li></ul><ul><li>Skin temperature and color </li></ul><ul><li>Allen test? </li></ul>
  37. 37. Pathologies
  38. 38. Pathologies <ul><li>Wrist injuries </li></ul><ul><li>Hand injuries </li></ul><ul><li>Finger injuries </li></ul><ul><li>Thumb injuries </li></ul>
  39. 39. Wrist Injuries <ul><li>Wrist sprains </li></ul><ul><li>Triangular fibrocartilage complex (TFCC) injury </li></ul><ul><li>Carpal tunnel syndrome </li></ul><ul><li>Wrist fractures </li></ul><ul><li>Scaphoid fractures </li></ul><ul><li>Lunate/perilunate dislocations </li></ul><ul><li>Neurological injuries </li></ul>
  40. 40. Wrist Sprains <ul><li>Most common etiology is hyperflexion or hyperextension (fall on outstretched arm) </li></ul><ul><li>Must rule out carpal fracture, neurological injury and TFCC injury before assessing as wrist sprain </li></ul><ul><li>Most common presentation involves limited ROM to all wrist movements due to pain, usually also presents with weakness – assess with radiocarpal and carpal glide tests - treated conservatively in nearly all cases </li></ul>
  41. 41. TFCC Injury <ul><li>Sprain to ligamentous structures on dorsal and medial aspect of wrist – injury occurs acutely, but often not reported until later </li></ul><ul><li>Most common etiology is hyperextension with ulnar deviation </li></ul><ul><li>Presents with tenderness to dorsal medial wrist distal to ulna, limited ROM (especially radial and ulnar deviation), possibility of avulsion fracture </li></ul><ul><li>Must be referred to MD – often surgically repaired </li></ul>
  42. 42. TFCC Injury
  43. 43. Carpal Tunnel Syndrome <ul><li>Compression of median nerve in carpal tunnel – must be able to differentiate from nerve root injury </li></ul><ul><li>Typically secondary to overuse conditions (tendonitis, etc.) but may be due to acute trauma </li></ul><ul><li>Most common presentation is neurological deficit/symptoms to median nerve distribution (sensory and motor) </li></ul>
  44. 44. Carpal Tunnel Syndrome <ul><li>Evaluate with Tinel’s sign to carpal tunnel – positive if symptoms reproduced </li></ul><ul><li>Evaluate with Phalen’s test – wrist flexion for ~1 minute – positive if symptoms reproduced </li></ul><ul><li>Almost always treated conservatively initially with rest, splinting (night), NSAIDs </li></ul><ul><li>Failure of conservative measures can lead to surgery – resection of transverse carpal ligament </li></ul>
  45. 45. Phalen’s Test
  46. 46. Wrist Fractures <ul><li>Typically occur from fall on outstretched arm – must consider neurovascular implications </li></ul><ul><li>Colles’ fracture </li></ul><ul><ul><li>Fracture of distal radius proximal to radiocarpal joint with dorsal displacement of fracture </li></ul></ul><ul><li>Smith’s fracture (reverse Colles’) </li></ul><ul><ul><li>Fracture of distal radius proximal to radiocarpal joint with palmar/volar displacement of fracture </li></ul></ul>
  47. 47. Colles’ Fracture
  48. 48. Smith’s Fracture
  49. 49. Scaphoid Fracture <ul><li>Easily the most commonly fractured carpal bone </li></ul><ul><li>Most common etiology is hyperextension </li></ul><ul><li>Blood supply comes from distal aspect and fracture in mid-substance often compromises proximal blood supply – high incidence of non-union/malunion fractures </li></ul>
  50. 50. Scaphoid Fracture
  51. 51. Scaphoid Fracture <ul><li>Common presentation is pain/tenderness to snuffbox, limited ROM due to pain (especially extension/radial deviation), decreased grip strength </li></ul><ul><li>Conservative management involves immobilization of wrist/thumb/forearm for 6-8 weeks, then progressive ROM/strengthening exercises </li></ul><ul><li>Surgical intervention occasionally done in acute situation, but usually after failed conservative approach </li></ul>
  52. 52. Perilunate and Lunate Dislocations <ul><li>Hyperextension is mechanism of injury – leads to 2 dislocation types (progressive severity of injury): perilunate dislocation vs. lunate dislocation </li></ul><ul><li>Common presentation is either palmar or dorsal wrist pain/swelling, visible/palpable deformity, 3 rd knuckle level with others, neurological symptoms (3 rd finger) </li></ul>
  53. 53. Perilunate Dislocation <ul><li>Palmar/volar displacement of proximal row of carpal bones on lunate so that lunate is dorsal to the other bones </li></ul><ul><li>Rupture of palmar/volar radiocarpal ligaments and promimal row of carpals “stripped” away from lunate </li></ul><ul><li>May spontaneously reduce, but usually remains displaced </li></ul>
  54. 54. Perilunate Dislocation
  55. 55. Lunate Dislocation <ul><li>Palmar/volar displacement of lunate relative to carpals (really vice versa – carpals displaced dorsally on lunate) </li></ul><ul><li>Further hyperextension forces ruptures dorsal radiocarpal ligaments and the carpals are subsequently displaced </li></ul><ul><li>May spontaneously reduce, but usually remains displaced </li></ul>
  56. 56. Lunate Dislocation
  57. 57. Perilunate and Lunate Dislocations <ul><li>If closed reduction is stable, immobilized in slight flexion for 6-8 weeks – regular re-evaluation to maintain reduction stability </li></ul><ul><li>Requires surgical stabilization if closed reduction not stable acutely or if conservative attempts fail </li></ul>
  58. 58. Neurological Injuries <ul><li>Median nerve – carpal tunnel syndrome </li></ul><ul><li>Ulnar nerve </li></ul><ul><ul><li>Passes in tunnel of Guyon between hook of hamate and pisiform, can be compressed </li></ul></ul><ul><li>Radial nerve </li></ul><ul><ul><li>Drop wrist syndrome from inability to extend wrist/fingers if radial nerve injured </li></ul></ul>
  59. 59. Hand and Finger Injuries <ul><li>Metacarpal fractures </li></ul><ul><li>Collateral ligament injuries </li></ul><ul><li>Posturing and deformities </li></ul><ul><li>Finger fractures </li></ul><ul><li>Dislocations </li></ul>
  60. 60. Metacarpal Fractures <ul><li>Etiology is direct trauma – injury to 4 th and 5 th are most common </li></ul><ul><ul><li>Boxer’s fracture: 5 th metacarpal fracture with “depression or shortening” of knuckle </li></ul></ul><ul><li>Often reports of hearing/feeling “pop or snap” at time of injury </li></ul><ul><li>Common presentation is localized tenderness/swelling/crepitus, possible displacement, abnormal hand ROM, weakness to affected area </li></ul>
  61. 61. Boxer’s Fracture
  62. 62. Metacarpal Fractures
  63. 63. Metacarpal Fractures <ul><li>If no displacement, treat with cast immobilization for 4-6 weeks followed by progressive ROM/flexibility/strengthening </li></ul><ul><li>If displacement and/or fragmented, surgical intervention necessary to re-establish normal anatomical positioning – then treated same as conservative approach </li></ul>
  64. 64. Collateral Ligament Injuries <ul><li>Etiology is acute force application </li></ul><ul><li>Present with localized pain/swelling, ROM limited due to pain/swelling </li></ul><ul><li>Varus and valgus stress tests often not informative unless 3 rd degree injury </li></ul><ul><li>Generally conservatively managed with splint and symptomatic treatment </li></ul>
  65. 65. Posturing and Deformities <ul><li>Ape hand </li></ul><ul><li>Bishop’s deformity </li></ul><ul><li>Claw hand </li></ul><ul><li>Dupuytern’s contracture </li></ul><ul><li>Swan neck deformity </li></ul><ul><li>Volkmann’s ischemic contracture </li></ul><ul><li>Boutonniere deformity </li></ul><ul><li>Trigger finger </li></ul>
  66. 66. Posturing and Deformities <ul><li>Ape hand </li></ul><ul><ul><li>Median nerve inhibition resulting in thenar eminence atrophy – inability to flex and oppose thumb </li></ul></ul><ul><li>Bishop’s deformity </li></ul><ul><ul><li>Ulnar nerve inhibition resulting in hypothenar eminence, interossei, and medial 2 lumbricale atrophy – 4 th and 5 th fingers assume flexed posture </li></ul></ul><ul><li>Claw hand </li></ul><ul><ul><li>Ulnar and median nerve pathology resulting in flexion of PIP and DIP joints with associated extension of MP joints </li></ul></ul>
  67. 67. Dupuytren’s Contracture <ul><li>Flexion contracture of MP and PIP joints from shortening/adhesions in palmar aponeurosis – most common at 4 th and 5 th fingers </li></ul>
  68. 68. Swan-Neck Deformity <ul><li>Flexion of MP and DIP joints with associated hyperextension of PIP joint – usually due to volar plate injury, but can have many causes </li></ul>
  69. 69. Volkmann’s Ischemic Contracture <ul><li>Flexion contracture of wrist and fingers from decreased blood supply to forearm muscles secondary to fracture, dislocation or compartment syndrome </li></ul>
  70. 70. Boutonniere Deformity <ul><li>Extension of MP and DIP joints with associated flexion of PIP joint – due to rupture of extensor tendon from middle phalanx causing it to slip laterally at PIP joint changing line of pull from extension to flexion </li></ul>
  71. 71. Trigger Finger <ul><li>“Locking” of ROM during finger flexion from adhesions in flexor tendon sheaths </li></ul><ul><li>With flexion movements, adhesions require additional effort to allow for flexion ROM </li></ul><ul><li>Tendon “release” often presents as an audible “snap” as finger moves into flexion </li></ul>
  72. 72. Trigger Finger
  73. 73. Finger Fractures <ul><li>Distal phalanx most commonly fractured due to flexor/extensor tendon attachments (avulsion) and crushing trauma </li></ul><ul><li>Middle phalanx uncommonly injured </li></ul><ul><li>Proximal phalanx injury usually not isolated and has associated tendon and/or skin injury </li></ul><ul><li>Presentation and treatment similar to metacarpal fracture discussion </li></ul>
  74. 74. Finger Fracture
  75. 75. Finger Fractures <ul><li>Avulsion fractures of the fingers </li></ul><ul><ul><li>Mallet finger </li></ul></ul><ul><ul><ul><li>Avulsion of extensor tendon from distal phalanx, inability to actively extend DIP joint (passive OK), commonly occurs if fingertip hits ball </li></ul></ul></ul><ul><ul><li>Jersey finger </li></ul></ul><ul><ul><ul><li>Avulsion of profundus tendon from distal phalanx, inability to actively flex DIP joint if PIP joint stabilized, commonly occurs when grabbing jersey and joint forcefully extended against active motion </li></ul></ul></ul>
  76. 76. Mallet Finger
  77. 77. Jersey Finger
  78. 78. Finger Dislocations <ul><li>Interphalangeal joint dislocations result in obvious deformity </li></ul><ul><li>Must rule out associated fracture – refer to MD for imaging prior to reduction </li></ul><ul><li>Generally, easy to reduce – must be splinted after reduction </li></ul>
  79. 79. Finger Dislocations
  80. 80. Thumb Injuries <ul><li>DeQuervain’s syndrome </li></ul><ul><li>Sprains </li></ul><ul><li>MP joint dislocations </li></ul><ul><li>Fractures </li></ul>
  81. 81. DeQuervain’s Syndrome <ul><li>Tenosynovitis of extensor pollicis brevis and abductor pollicis longus tendons from repetitive stress (radial deviation) </li></ul><ul><li>Presents with pain/swelling to proximal thumb/distal radius, pain with radial/ulnar wrist deviation and thumb extension and abduction </li></ul><ul><li>Treated conservatively with rest (immobilization), NSAIDs, modalities </li></ul>
  82. 82. DeQuervain’s Syndrome
  83. 83. Finkelstein’s Test <ul><li>Evaluative for DeQuervain’s syndrome </li></ul><ul><li>Thumb flexed across palm and locked in by finger flexion – wrist placed in ulnar deviation – positive if pain reproduced or increased </li></ul><ul><li>Can present with false-positive results </li></ul>
  84. 84. Finkelstein’s Test
  85. 85. Thumb Sprains <ul><li>Medial (ulnar) collateral ligament of 1 st MP joint is easily most commonly injured – must rule out avulsion fracture </li></ul><ul><li>May be due to repetitive stress, but typically etiology is acute hyperextension and/or hyperabduction (skiing, etc.) – Gamekeeper’s thumb </li></ul>
  86. 86. Thumb Sprains <ul><li>Commonly presents with localized tenderness/swelling, may see ecchymosis in thenar eminence, inability to pinch or grasp objects, positive valgus stress test </li></ul><ul><li>If mild or moderate injury with good end point, often treat conservatively with splint for 4-6 weeks </li></ul><ul><li>If rupture, early surgical intervention indicated to provide acceptable joint stability </li></ul>
  87. 87. 1 st MP Joint UCL Sprain
  88. 88. 1 st MP Joint Dislocation <ul><li>Etiology usually hyperextension and/or hyperabduction – may have associated fracture </li></ul><ul><li>Rupture of volar (palmar) ligamentous structure </li></ul><ul><li>Presents with obvious deformity and inability to perform ROM </li></ul><ul><li>Refer to MD for reduction </li></ul>
  89. 89. Thumb Dislocation
  90. 90. Thumb Fractures <ul><li>1 st metacarpal fractures due to acute trauma </li></ul><ul><li>If fracture extends into articular surface (joint space), known as Bennett’s fracture </li></ul><ul><li>Bennett’s fracture often requires surgical intervention to fixate fracture segment to allow for normal bony alignment and stability </li></ul>
  91. 91. Bennett’s Fracture

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