Symptoms and Treatment of Hand Pain:

Hand and finger injuries finger injuries are extremely common in sport and, although the majority require minimal treatment, some are potentially serious and require immobilization, precise splinting, or even surgery. Finger injuries are often neglected by athletes in the expectation that they will resolve spontaneously. Many present too late for effective treatment. The importance of early assessment and management must be stressed so that long-term deformity and functional impairment can be avoided. Many hand and finger injuries require specific rehabilitation and appropriate protection upon resumption of sport. Joints in this region do not respond well to immobilization, therefore, full immobilization should be minimized.

Mechanism of Injury:

The mechanism of injury is the most important component of the history of acute hand injuries. A direct, severe blow to the fingers may result in a fracture, whereas a blow to the point of the finger may produce an interphalangeal dislocation, joint sprain or long flexor or extensor tendon avulsion. A punching injury often results in a fracture at the base of the first metacarpal or to the neck of one of the other metacarpals usually the fifth. An avulsion of the flexor digitorum profundus tendon, usually to the fourth finger, is suggested by a history of a patient grabbing an opponent’s clothing while attempting a tackle. Associated features such as an audible crack, degree of pain, swelling, bruising, and loss of function should also be noted.

Signs and Symptoms:

Carefully palpate the bones and soft tissues of the hand and fingers, looking for tenderness. The examiner should always be conscious of what structure is being palpated at any particular time. The joints should be examined to determine active and passive range of movement and stability. Stability should be tested both in an anteroposterior direction and with ulnar and radial deviation to assess the collateral ligaments. The cause of any loss of active range of movement should be carefully assessed and not presumed to be due to swelling. Normal range of motion for the second to fifth digits is approximately 80 degree of flexion at the DIP, 100 degree of flexion at the PIP and 90 degree of flexion at the MCP joint. A common injury site that can be overlooked is the volar plate, a thick fibrocartilagenous tissue that reinforces the phalangeal joints on the palmer or volar surface.

The extensor tendons of the hand are often divided into six compartments. At the wrist on the dorsal side of the hand, the tendons are encased in synovial sheaths as they pass under the extensor retinaculum. When palpating in the most radial of the distal end of the radius. The extensor pollicis longus angles sharply around the bony prominence and can damage or even rupture the tendon after a serious wrist fracture. The anatomical snuffbox is composed of the extensor pollicis longus and brevis and abductor pollicis longus. The floor of the snuffbox is the carpometacarpal joint of the thumb. Clinically this is a significant region for several reasons. Tenderness may suggest scaphoid fracture. The deep branch of the radial arterial passes through as well as the superficial branch of the radial nerve; consequently, if a cast or splint is applied too tightly, it can lead to numbness in the thumb.

Examination Involves:

1. Observation and sensation testing as per the wrist. Special note should be made of the hand arches and any deformities at the proximal or distal interphalangeal joints.

• Hand at rest
• Hand with clenched fist

2.  Active movements-fingers (all Joints)

• Flexion
• Extension
• Abduction
• Adduction

3.  Active movements-thumb

• Flexion
• Extension
• Palmar abduction
• Palmar adduction
• Opposition

4.  Resisted movements (tendons)

• Flexor digitorum profundus
• Flexor digitorum superficialis
• Extensor tendon

5. Special test

• Ulnar collateral ligament of the first MCP joint
• IP joint collateral ligaments

Diagnosis of Hand Injuries:

Routine radiographs of the hand include the PA, oblique and lateral views. All traumatic finger injuries should be X-rayed. Ideally, ‘dislocations’ need to be radiographed before reduction to exclude fracture and after reduction to confirm relocation. Even when pre-reduction radiographs are not performed because reduction has occurred on the field, post-reduction films should be obtained after the game. Care should be taken with lateral views to isolate the affected finger to avoid bony overlap. The use of more sophisticated investigation techniques is usually not required.

Treatment of Hand Injuries:

• The functional hand requires mobility, stability, sensitivity, and freedom from pain. It may be necessary to obtain stability by surgical methods.
• However, conservative rehabilitation is essential to regain mobility and long-term freedom from pain, Treatment and rehabilitation of hand injuries is complex.
• As the hand is unforgiving of mismanagement, practitioners who do not see hand injuries regularly should ideally refer patients to an experienced hand therapist, or at least obtain advice while managing the patient.
• Inflammation and swelling are obvious in the hand and fingers.
• During the inflammatory phase, the therapist must aim to reduce edema and monitor progress by signs of redness, heat and increased pain.
• During the regenerative phase (characterized by proliferation of scar tissue), the therapist can use supportive splints and active exercises to maintain range of motion.
• During remodeling, it is appropriate to use dynamic and serial splints, and active and active assisted exercises, in addition to heat, stretching and electrotherapeutic modalities.