Hand and Finger Injuries: Metacarpal Fractures.

Metacarpal fractures are common. Many metacarpal fractures without malrotation, particularly fifth metacarpal neck fractures, can be managed nonsurgically. However, intraarticular and extraarticular metacarpal fractures of the thumb are subject to tendon forces and often displace. Patients with such fractures require referral to an orthopedic surgery subspecialist for possible surgical intervention, as do patients with metacarpal fractures that have intraarticular involvement, malrotation, shortening greater than 6 mm, or excessive angulation.

Hand and Finger Injuries: Finger Fractures and Dislocations.

Many finger fractures can be managed nonsurgically. Patients with fractures that include angulation, comminution, and malrotation must be referred expeditiously to a hand surgeon, preferably within 1 week. Some fractures, such as condylar fractures, appear nondisplaced at first but have a high propensity to displace and, therefore, also should be referred to a subspecialist. The management of mallet fractures is controversial, with studies supporting surgical and nonsurgical options.

Hand and Finger Injuries: Tendon and Soft Tissue Injuries of the Hand.

Patients with any laceration or wound over the hand need to be evaluated for tendon and neurovascular injuries. Patients with these injuries should receive urgent wound care as well as splinting and expeditious referral for surgical repair because lacerated tendons and nerves cannot heal without surgical approximation. Conversely, ligament injuries of the hand, such as disruption of the ulnar collateral ligament of the metacarpophalangeal joint of the thumb, can sometimes be managed nonsurgically if the joint is stable and there is no Stener lesion. If nonsurgical management does not stabilize the joint, patients should be referred for surgery. Stener lesions, where the ulnar collateral ligament at the metacarpophalangeal joint of the thumb has torn and retracted proximal to the adductor pollicis, always require surgery for the ligament to heal and for the best outcomes; however, surgery is not urgent.

Hand and Finger Injuries: Chronic Hand and Wrist Pathologies.

Common chronic hand pathologies seen by family physicians include carpal tunnel syndrome, trigger finger, and de Quervain tenosynovitis. Carpal tunnel syndrome is the most common compressive neuropathy of the upper extremity and is caused by compression of the median nerve at the wrist. Trigger finger, also known as stenosing tenosynovitis, is caused by a metaplasia of the A1 flexor tendon pulley and the flexor tendon causing increased friction and decreased space for tendon gliding in the flexor tendon sheath. de Quervain tenosynovitis has a similar metaplasia of the tissues of the first dorsal extensor compartment over the radial styloid. For these pathologies, nonsurgical management includes activity modification, immobilization, and corticosteroid injections. Lack of benefit from these nonsurgical options is an indication for surgical referral.

Correlation of single leg vertical jump, single leg hop for distance, and single leg hop for time.

OBJECTIVES: To determine the correlation among three functional tests: single leg vertical jump (SLVJ), single leg hop for distance (SLHD), and single leg hop for time (SLHT). DESIGN: Prospective correlational investigation. SETTING: University research laboratory. PARTICIPANTS: Forty healthy men (n = 19) and women (n = 21) between the ages of 18 and 30 (23.9 ± 2.0 years). MAIN OUTCOME MEASURES: SLVJ was measured using the Vertec. SLHD was measured using a standard tape measure. SLHT was measured over a 10-m course using a standard stopwatch. RESULTS: The strongest correlation was between SLHT and SLHD, -0.89 and -0.89 for dominant and non-dominant lower extremities (LE), respectively. The weakest pairwise correlation was between SLVJ and SLHT, -0.71 and -0.63 for dominant and non-dominant LE, respectively. The correlation between SLVJ and SLHD was 0.74 and 0.71 for dominant and non-dominant LE, respectively. CONCLUSION: There is a strong correlation between SLHT and SLHD, suggesting that each test measures similar constructs of function, while the modest correlation between SLVJ and SLHT suggest these two tests do not measure the same functional components, and could be paired as outcome measures for the clinical assessment of lower extremity function.