Clinical Presentation Typical symptoms include pain and swelling with loss of motion in the affected finger ( Phalangeal Neck (Finger) Fracture, n.d.). Conservative treatment is used most often. Approximately one-fourth of phalangeal fractures require surgery (Kremer et al., 2022).
WRIST OVERUSE INJURIES
Intersection syndrome Intersection syndrome involves the first and second compartments of the wrist extensors and occurs when the tendons of the first dorsal compartment cross over the second. This creates a tenosynovitis (Michols & Kiel, 2023). The first compartment contains the abductor pollicis longus and the extensor pollicis brevis, while the second compartment contains the extensor carpi radialis longus and the extensor carpi radialis brevis (Balakatounis et al., 2017). When inflamed, pain and crepitus are located about 4 cm proximal to the wrist (Gil & Weiss, 2020). Intersection syndrome occurs most frequently in activities requiring repetitive flexion and extension of the wrist, such as racquet sports, rowing, canoeing, skiing, and horseback riding (Michols & Kiel, 2023). De Quervain syndrome De Quervain syndrome (DQS) , also known as first dorsal compartment tendinitis, is a common overuse injury of the wrist in athletes (Gil & Weiss, 2020). This condition is caused by repetitive shearing of the abductor pollicis longus and extensor pollicis brevis at the undersurface of the sheath of the first dorsal compartment at the radial styloid (Gil & Weiss, 2020). DQS most commonly occurs in women between 30 and 50 years of age who use repetitive hand or wrist motions in daily activities, but it also occurs in men who regularly engage in sports or manual labor (Fakoya et al., 2023). Clinical Presentation Patients report pain at the radial styloid process that increases with twisting and grasping activities (Gil & Weiss, 2020). Pain may also be present with active thumb motion, forming a fist, or lifting something with the thumbs up (like lifting a child). Tenderness and swelling may be present along the first dorsal compartment over the radial styloid (Goel & Abzug, 2015). Hand nerve compression syndromes Three nerves provide sensory and motor function in the hand—median, ulnar, and radial—and all of them can sustain compression injuries. Median nerve The median nerve is a mixed motor and sensory nerve. In the hand, it provides motor innervation to the flexor pollicis brevis, abductor pollicis brevis, opponens pollicis, and lateral two lumbricals. It provides sensory supply to the lateral palm, palmar aspect of the lateral three and a half fingers, and dorsal aspect of the lateral three and a half fingers distal to the proximal interphalangeal (PIP) joint (Sharrak & Das, 2023). Compression of the median nerve at the wrist is described as carpal tunnel syndrome (CTS). Its onset is related to occupations that require a high degree of repetitive hand activity, such as assembly and typing. One factor that
Clinical Presentation Patients with intersection syndrome typically complain of pain and tenderness along the dorsal aspect of the wrist proximal to the radial styloid. Swelling may be present, and crepitus may be palpable with wrist and/or thumb extension (Michols & Kiel, 2023). Differential diagnosis mainly includes De Quervain syndrome. With De Quervain syndrome, pain is more distal, at the dorsal interphalangeal joint of the thumb. Other pathologies to differentiate from intersection syndrome include scaphoid fracture, osteoarthritis of the first metacarpal joint, ganglion cysts, and Wartenberg syndrome (Balakatounis et al., 2017). Special tests include: ● Finkelstein’s test : For this test, the affected arm is extended with the wrist at the edge of the treatment table. The arm is positioned so For this test, the affected arm is extended with the wrist at the edge of the treatment table. The arm is positioned so that the ulnar aspect of the forearm is on the table and the ulnar aspect of the hand is hanging off the edge. First the client is asked to actively ulnarly deviate the wrist. If this does not elicit pain, the assessor can passively ulnarly deviate the wrist, as this increases traction across the first dorsal compartment. The test is positive if pain is reported over the styloid process (Som et al., 2023). ● Eichhoff test : This test involves placement of the client’s forearm as described for the Finkelstein test. In this position, the client opposes the thumb across the palm and then makes a fist. This test involves placement of the client’s forearm as described for the Finkelstein test. In this position, the client opposes the thumb across the palm and then makes a fist. Then the examiner passively moves the wrist into ulnar deviation. The test is positive if pain is reported over the styloid process (Fakoya et al., 2023). influences the development of carpal tunnel syndrome is obesity, as it increases fluid accumulation in the spaces of the carpal tunnel. Other factors that influence the development of this condition include diabetes, pregnancy, and hypothyroidism (Sharrak & Das, 2023). Clinical Presentation Symptoms of CTS include numbness, tingling, and pain that is worse at night. Prolonged wrist flexion and/or extension can elicit these symptoms. Patients may report weakness or clumsiness when using the hand to grasp or grip. Physical examination of sensory symptoms may find decreased sensation of the thumb, index, and middle fingers, as well as the lateral half of the ring finger. Thumb abduction may be weak (Sharrak & Das, 2023).
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