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Hand Trauma

  • Anand Kirwadi
  • Nikhil A. Kotnis
  • Andrew Dunn
Part of the Medical Radiology book series (MEDRAD)

Abstract

Hand injuries account for a large proportion of all injuries presenting to emergency departments. Avulsion injuries of the FDP tendons are a common sporting injury. Bowstringing of the flexor tendons are an important imaging sign of multiple annular pulley injuries. Mallet finger is the most common closed tendon injury in a sportsman. Rupture of the volar plate is a common complication of hyperextension injury. Imaging plays a crucial role in management of collateral ligament injuries. The extensor mechanism of the fingers is extremely intricate. Understanding relevant anatomy is quintessential for diagnosing and treating extensor mechanism injuries. Intra-articular metacarpal base fractures are commonly missed on initial presentation and pronated oblique radiographs help demonstrate the severity of this injury. Imaging evaluation of sports-related injuries of the hand should begin with radiographs. Ultrasound and magnetic resonance imaging play a vital role in diagnoses of soft tissue injuries. CT may be useful in understanding complex bony injuries.

Keywords

Flexor Tendon Extensor Tendon Ulnar Collateral Ligament Volar Plate Radial Collateral Ligament 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgments

The authors wish to sincerely thank Dr. David Moore, Dr. Steven L. J. James and Dr. Andrew J. Grainger for providing some of the images used in this chapter.

References

  1. Aitken S, Court-Brown CM (2008) The epidemiology of sports-related fractures of the hand. Injury 39:1377–1383PubMedCrossRefGoogle Scholar
  2. Angermann P, Lohmann M (1993) Injuries to the hand and wrist. A study of 50,272 injuries. J Hand Surg Br 18(5):642–644PubMedCrossRefGoogle Scholar
  3. Aronowitz ER, Leddy JP (1998) Closed tendon injuries of the hand and wrist in athletes. Clin Sports Med 17:449–467PubMedCrossRefGoogle Scholar
  4. Beltran J, Noto AM, Herman LJ, Lubbers LM (1987) Tendons: High field strength surface coil MR imaging. Radiology 162:735–740PubMedGoogle Scholar
  5. Bettinger PC, Linscheid RL, Berger RA, Cooney WP III, An KN (1999) An anatomic study of the stabilizing ligaments of the trapezium and trapeziometacarpal joint. J Hand Surg 24(4):786–798CrossRefGoogle Scholar
  6. Bollen (1990) Injury to the A2 pulley in rock climbers. J Hand Surg Br. May 15(2):268–70Google Scholar
  7. Brzezienski MA, Schneider LH (1995) Extensor tendons injuries at the distal interphalangeal joint. Hand Clin 11:373–386PubMedGoogle Scholar
  8. Burotn RI (1982) Extensor tendon-late reconstruction. In Green DP (ed): Operative Hand Surgey. New York, Churchill Livinstone p. 2073Google Scholar
  9. Buscemi MJ, Page BJ (1987) Flexor digitorum profundus avulsions with associated distal phalanx fractures: A report of four cases and review of the literature. Am J Sports Med 15:366–370PubMedCrossRefGoogle Scholar
  10. Cain JE, Shepler TR and Wilson MR (1987) Hamatometacarpal fracture-dislocation: classification and treatment. J Hand Surg. 12A:5(1):762–767Google Scholar
  11. Campbell CS (1955) Gamekeeper’s thumb. J Bone Joint Surg Br 37:148–149PubMedGoogle Scholar
  12. Carlsen BT, Moran SL (2009) Thumb trauma: Bennett fractures, rolando fractures, and ulnar collateral ligament injuries. J Hand Surg Am 34(5):945–952PubMedCrossRefGoogle Scholar
  13. Clavero JA, Alomar X, Monill JM, Esplugas M, Golano P, Mendoza M, Salvador A (2002) MR imaging of ligament and tendon injuries of the fingers. RadioGraphics 22:237–256PubMedGoogle Scholar
  14. Cooney WP, Arnold D, Grace J (1990) Collateral ligament injury of the thumb. Adv Orthop Surg 13:235–248Google Scholar
  15. Coyle MP Jr (2003) Grade III Radial collateral ligament injuries of the thumb metacarpophalangeal joint: Treatment by soft tissue advancement and bony reattachment. J Hand Surg Am 28(1):14–20PubMedCrossRefGoogle Scholar
  16. Derkash RS, Matyas JR, Weaver JK et al (1987) Acute surgical repair of the skier’s thumb. Clin Orthop Relat Res 216:29–33PubMedGoogle Scholar
  17. Doyle JR (1999) Extensor tendons—acute injuries. In: Geen DP, Hotchkiss RN, Pederson WC (eds) Green’s operative hand surgery, 4th edn. Churchill Livingstone, Edinburgh, pp 1950–1986Google Scholar
  18. Drape JL, Dubert T, Silbermann O, Thelen P, Thivet A, Benacerraf R (1994) Acute trauma of the extensor hood of the metacarpophalangeal joint: MR imaging evaluation. Radiology 192:469–476PubMedGoogle Scholar
  19. Eaton RG (1971) Joint injuries of hand. Charles C. Thomas, SpringfieldGoogle Scholar
  20. Ebrahim SF, De Maeseneer M, Jager T, Marcelis S, Jamadar DA, Jacobson JA (2006) US diagnosis of UCL tears of the thumb and stener lesions: technique, pattern-based approach, and differential diagnosis. Radiographics 26:1007–1020PubMedCrossRefGoogle Scholar
  21. Edelstein DM, Kardashian G, Lee SK (2008) Radial collateral ligament injuries of the thumb. J Hand Surg 33A:760–770Google Scholar
  22. Elson RA (1986) Rupture of the central slip of the extensor hood of the finger. A test for early diagnosis. J Bone Joint Surg Br 68(2):229–231PubMedGoogle Scholar
  23. Gabl M, Rangger C, Lutz M, Fink C, Rudisch A, Pechlaner S (1998) Disruption of the finger flexor pulley system in elite rock climbers. Am J Sports Med 26:651–655PubMedGoogle Scholar
  24. Gaine WJ, Beardsmore J, Fahmy N (1998) Early active mobilisation of volar plate avulsion fractures. Injury 29:589–591PubMedCrossRefGoogle Scholar
  25. Gerber C, Senn E, Matter P (1981) Skier’s thumb: Surgical treatment of recent injuries to the ulnar collateral ligament of the thumb’s metacarpophalangeal joint. Am J Sports Med 9:171–177PubMedCrossRefGoogle Scholar
  26. Giele H, Martin J (2003) The two-level ulnar collateral ligament injury of the metacarpophalangeal joint of the thumb. J Hand Surg 28B:92–93Google Scholar
  27. Green DP, Rowlan SA (1984) Fractures and dislocations in the hand. In: Rockwood CA Jr, Green DP (eds) Fractures in adults, 2nd edn. JB Lippincott, Philadelphia, pp 388–394Google Scholar
  28. Griffin M, Hindocha S, Jordan D, Saleh M, Khan W (2012) Management of extensor tendon injuries. Open Orthop J 6(Suppl 1:M4):36–42Google Scholar
  29. Hame SL, Melone CP Jr (2000) Boxer’s knuckle in the professional athlete. Am J Sports Med 28:879882Google Scholar
  30. Handoll HHG, Vaghela M (2004) Interventions for treating mallet finger injuries. Cochran Database Syst Rev (1) Google Scholar
  31. Harper MT, Chandnani VP, Spaeth J, Santangelo JR, Providence BC, Bagg MA (1996) Gamekeeper thumb: Diagnosis of ulnar collateral ligament injury using magnetic resonance imaging, magnetic resonance arthrography and stress radiography. J Magn Reson Imaging 6(2):322–328PubMedCrossRefGoogle Scholar
  32. Hart RG, Uehara DT, Kutz JE (1993) Extensor tendon injuries of the hand. Emerg Med Clin North Am 11(3):637–649PubMedGoogle Scholar
  33. Hauger O, Chung CB et al (2000) Pulley System in the fingers: normal anatomy and simulated Lesions in cadavers at MR Imaging, CT and US with and without contrast material distention of the tendon sheath. Radiology 217:201–212PubMedGoogle Scholar
  34. Hergan K, Mittler C, Oser W (1995) Ulnar collateral ligament: differentiation of displaced and nondisplaced tears with US and MR imaging. Radiology 194:65–71PubMedGoogle Scholar
  35. Hergan K, Mittler C, Oser W (1997) Pitfalls in sonography of the gamekeeper’s thumb. Eur Radiol 7:65–69PubMedCrossRefGoogle Scholar
  36. Heyman P, Gelberman RH, Duncan K, Hipp JA (1993) Injuries of the ulnar collateral ligament of the thumb metacarpophalangeal joint: Biomechanical and prospective clinical studies on the usefulness of valgus stress testing. Clin Orthop Relat Res 292:165–171PubMedGoogle Scholar
  37. Hill C, Riaz M, Mozzam A, Brennen ND (1998) A regional audit of hand and wrist injuries. J Hand Surg (Br Eur) 23B(2):196–200CrossRefGoogle Scholar
  38. Hong E (2005) Hand injuries in sports medicine. Prim Care 32:91–103PubMedCrossRefGoogle Scholar
  39. Hunter JM (1984) Anatomy of the flexor tendons: pulley, vincular, synovial, and vascular structures. In: Spinner M (ed) Kaplan’s functional and surgical anatomy of the hand, 3rd edn. Lippincott, Philadelphia, pp 65–92Google Scholar
  40. Hussain SN, Dietz JF, Kalainov DM, Lautenschlager EP (2008) A biomechanical study of distal interphalangeal joint subluxation after mallet fracture injury. J Hand surg 33A:26–30Google Scholar
  41. Inoue G and Tamura Y (1996). Dislocation of the extensor tendons over the metacarpophalangeal joints. J Hand Surg (Am) 21:464–469Google Scholar
  42. Jebson PJL (1998) Flexor digitorum profundus tendon avulsions. Oper Tech Orthop 8:63–66CrossRefGoogle Scholar
  43. Jeyapalan K, Bisson MA, Dias JJ, Griffin Y, Bhatt R (2008) The role of ultrasound in the management of flexor tendon injuries. J Hand Surg (Eur) 33E(4):430–434Google Scholar
  44. Keifhaber TR, Stern PJ (1998) Fracture dislocations of the proximal interphalangeal joint. J Hand Surg Am 23:368–380CrossRefGoogle Scholar
  45. Kichouh M, De Maesenner M, Jager T, Marcelis S, Van Hedent E, Van Roy P, De Mey J (2011) Ultrasound findings in injuries of dorsal extensor hood: Correlation with MR and follow-up findings. Eur J Radiol 77:249–253PubMedCrossRefGoogle Scholar
  46. Klauser A, Bodner G, Frauscher F, Gabl M, Xur Nedden D (1999) Finger injuries in extreme rock climbers assessment of high-resolution ultrasonography. Am J Sports Med 27:733–737PubMedGoogle Scholar
  47. Klauser A, Frauscher F, Bodner G, Halpern E, Schoke MF, Springer P, Gable M, Judamaier W, Nedden D (2002) Finger pulley injuries in extreme rock climbers: depiction with dynamic US. Radiology 222:755–761PubMedCrossRefGoogle Scholar
  48. Kleinbaum Y, Heyman Z, Ganel A, Blankstein A (2005) Sonographic imaging of mallet finger. Ultraschall Med 26(3):223–226PubMedCrossRefGoogle Scholar
  49. Kleinhert HE, Verdan C (1983) Report of the committee on tendon injuries. J Hand Surg (Am) 8(5 pt 2):794–798Google Scholar
  50. Le Viet D, Rousselin B, Roulot E, Lantieri L, Godefroy D (1996) Diagnosis of digital pulley rupture by computed tomography. Hand Surg 21A:245–248Google Scholar
  51. Leddy JP, Packer JW (1977) Avulsion of the profundus tendon insertion in athletes. J Hand Surg (Am) 2:66–69Google Scholar
  52. Lee SG, Jupiter JB (2000) Phalangeal and metacarpal fractures of the hand. Hand Clin 16:323–332PubMedGoogle Scholar
  53. Liaw Y, Kalnins G, Kirsh G, Meakin I (1995) Combined fourth and fifth metacarpal fracture and fifth carpometacarpal joint dislocation. J Hand surg (Br Eur) 20B(2):249–252CrossRefGoogle Scholar
  54. Lin GT, Amadio PC, An KN, Cooney WP (1989) Functional anatomy of the human digital flexor pulley system. J Hand Surg Am 14:949–956PubMedCrossRefGoogle Scholar
  55. London PS (1971) Sprains and fractures involving the interphalangeal joints. Hand 3:155–158PubMedCrossRefGoogle Scholar
  56. Lopez-Ben R, Lee DH, Nicolodi DJ (2003) Boxer knuckle (injury of the extensor hood with extensor tendon subluxation: diagnosis with dynamic us—report of three cases. Radiology 228:642–646PubMedCrossRefGoogle Scholar
  57. Lyons RP, Kozin SH, Failla JM (1998) The anatomy of the radial side of the thumb: static restraints in preventing subluxation and rotation after injury. Am J Orthop 27:759–763PubMedGoogle Scholar
  58. Marco RA, Sharkey NA, Smith TS, Zissimos AG (1998) Pathomechanics of closed rupture of the flexor tendon pulleys in rock climbers. J Bone Joint Surg Am 80:1012–1019PubMedGoogle Scholar
  59. Martinoli C, Bianchi S, Nebiolo M, Dechi LE, Garcia JF (2000) Sonographic evaluation of digital annular pulley tears. Skeletal Radiol 29:387–391PubMedCrossRefGoogle Scholar
  60. Matzon JL, Bozentka DJ (2010) Extensor tendon injuries. J Hand surg 35A:854–861Google Scholar
  61. McMaster PE (1933) Tendon and muscle ruptures: clinical and experimental studies on the causes and location of subcutaneous ruptures. J Bone Joint Surg 15:705Google Scholar
  62. Morgan WJ, Slowman LS (2001) Acute hand and wrist injuries in athletes: evaluation and management. J Am Acad Orthop Surg 9:389–400PubMedGoogle Scholar
  63. Nance EP Jr, Kaye JJ, Milek MA (1979) Volar plate fractures. Radiology 133:61–64PubMedGoogle Scholar
  64. Newport ML (1997) Extensor tendon injuries in the hand. J Am Acad Orthop Surg 5:59–66PubMedGoogle Scholar
  65. Patel S, Potty A, Taylor EJ, Sorene ED (2010) Collateral ligament injuries of the metacarpophalangeal joint of the thumb: a treatment algorithm. Strat Trauma Limb Reconstr 5:1–10CrossRefGoogle Scholar
  66. Perron AD, Brady WJ, Keats TE, Hersh RE (2001) Orthopaedic pitfalls in the emergency department: closed tendon injuries of the hand. Am J Emerg Med 19:76–80PubMedCrossRefGoogle Scholar
  67. Peterson JJ, Bancroft LW (2006) Injuries of the fingers and thumb in the athlete. Clin Sports Med 25:527–542PubMedCrossRefGoogle Scholar
  68. Phair IC, Quinton DN, Allen MJ (1989) The conservative management of volar avulsion fractures of the PIP joint. J Hand Surg Br 14:168–170PubMedCrossRefGoogle Scholar
  69. Posner MA (1977) Injuries to the hand and wrist in athletes. Orthop Clin North Am 8:593–618PubMedGoogle Scholar
  70. Rayan GM, Murray D (1994) Classification and treatment of closed sagittal band injuries. J Hand Surg 19A:590–594Google Scholar
  71. Rettig AC (2004) Athletic injuries of the wrist and hand. Part II: overuse injuries of the wrist and traumatic injuries to the hand. Am J Sports Med 32:262–273PubMedCrossRefGoogle Scholar
  72. Ritts GD, Wood MB, Engber WD (1985) Nonoperative treatment of traumatic dislocations of the extensor digitorum tendons in patients without rheumatoid disorders. J Hand Surg 10A:714–716Google Scholar
  73. Rockwell WB, Butler PN and Byrne BA (2000) Extensor Tendon: Anatomy, Injury, and Reconstruction. Plastic and Reconstructive surgery 106: 1592- 1603Google Scholar
  74. Schnur DP, DeLone FX, McClellan MR, Bonavita J, Witham RS (2002) Ultrasound: A powerful tool in the diagnosis of ulnar collateral ligament injuries of the thumb. Ann Plast Surg 49:19–23PubMedCrossRefGoogle Scholar
  75. Smith RJ (1977) Post-traumatic instability of the metacarpophalangeal joint of the thumb. J Bone Joint Surg (Am) 59-A:14–21Google Scholar
  76. Sollerman C, Abrahamso SO, Lundborg G, Adalbert K (1991) Functional splinting versus plaster cast for ruptures of the ulnar collateral ligament of the thumb. Acta Orthop Scand 62:524–526PubMedCrossRefGoogle Scholar
  77. Stanton JS, Dias JJ, Burke FD (2007) Fractures of the tubular bones of the hand. J Hand Surg 32E:626–636Google Scholar
  78. Stark HH, Boyes JH, Wilson JN (1962) Mallet finger. J Bone Joint Surg Am 44(6):1061–1068PubMedGoogle Scholar
  79. Stener B (1962) Displacement of the ruptured ulnar collateral ligament of the metacarpo-phalangeal joint of the thumb. J Bone Joint Surg (Br) 44-B:869–879Google Scholar
  80. Stern PJ (2005) Fractures of the metacarpals and phalanges. In: Green DP (ed) Green’s operative hand surgery, 5th edn. Elsevier Churchill Livingstone, PhiladelphiaGoogle Scholar
  81. Tabbal GN, Bastidas N, Sharma S (2009) Closed mallet thumb injury: a review of the literature and case study of the use of magnetic resonance imaging in deciding treatment. Plast Reconstr Surg 124(1):222–226PubMedCrossRefGoogle Scholar
  82. Tang P (2011) Collateral ligament injuries of the thumb metacarpophalangeal joint. J Am Acad Orthop Surg 19:287–296PubMedGoogle Scholar
  83. Tsiouri C, Hayton MJ, Baratz M (2009) Injury to the ulnar collateral ligament of the thumb. Hand 4:12–18PubMedCrossRefGoogle Scholar
  84. Walsh JJ (2004) Fractures of the hand and carpal navicular bone in athletes. South Med J 97:762–765PubMedCrossRefGoogle Scholar
  85. Weinstein LP, Hanel DP (2002) Metacarpal fractures. J Am Soc Surg Hand 2:168–180CrossRefGoogle Scholar
  86. Williams EH, McCarthy E, Bickel KD (1998) J Hand Surg Am 23A:805–810CrossRefGoogle Scholar
  87. Yoong P, Goodwin RW, Chojnowski A (2010) Phalangeal fractures of the hand. Clin Radiol 65:773–780PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg  2013

Authors and Affiliations

  1. 1.Department of RadiologyNorthern General Hospital, Sheffield Teaching Hospitals NHS Foundation TrustSheffieldUK
  2. 2.Department of RadiologyRoyal Liverpool University Hospitals NHS trustLiverpoolUK

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