Made by DATEXIS (Data Science and Text-based Information Systems) at Beuth University of Applied Sciences Berlin
Deep Learning Technology: Sebastian Arnold, Betty van Aken, Paul Grundmann, Felix A. Gers and Alexander Löser. Learning Contextualized Document Representations for Healthcare Answer Retrieval. The Web Conference 2020 (WWW'20)
Funded by The Federal Ministry for Economic Affairs and Energy; Grant: 01MD19013D, Smart-MD Project, Digital Technologies
Hand and wrist injuries are reported to account for fifteen to twenty percent of emergency room injuries, and metacarpal fractures represent a significant number of those injuries. Hand injuries of this sort are most prevalent among fifteen- to thirty-five-year-old males, and the fifth metacarpal is the one most commonly affected.
Males are nearly fifty percent more likely to sustain fracture from a punch mechanism than females. Male intentional punch injuries are correlated predominantly with social deprivation, while female punch intentional injuries show more correlation with psychiatric disorders.
Approximately 3.7 male hand injuries, per 1000, per year, and 1.3 female hand injuries, per 1000, per year, have been reported. Common mechanisms of injury are gender specific. Although the fiscal cost is not available, it can be asserted that the cost is reasonably significant per individual, depending on the cost of emergency care, immobilization, surgery, follow up doctors’ visits, etc. in addition to the fiscal impact from loss of and/or limited work abilities.
About 1.8 million people go to the emergency department each year due to hand injuries.
Dupuytren’s disease has a high recurrence rate, especially when a person has so called Dupuytren’s diathesis. The term diathesis relates to certain features of Dupuytren's disease and indicates an aggressive course of disease.
The presence of all new Dupuytren’s diathesis factors increases the risk of recurrent Dupuytren’s disease by 71% compared with a baseline risk of 23% in people lacking the factors. In another study the prognostic value of diathesis was evaluated. They concluded that presence of diathesis can predict recurrence and extension. A scoring system was made to evaluate the risk of recurrence and extension evaluating the following values: bilateral hand involvement, little finger surgery, early onset of disease, plantar fibrosis, knuckle pads and radial side involvement.
Minimally invasive therapies may precede higher recurrence rates. Recurrence lacks a consensus definition. Furthermore, different standards and measurements follow from the various definitions.
The etiology of the Galeazzi fracture is thought to be a fall that causes an axial load to be placed on a hyperpronated forearm. However, researchers have been unable to reproduce the mechanism of injury in a laboratory setting.
After the injury, the fracture is subject to deforming forces including those of the brachioradialis, pronator quadratus, and thumb extensors, as well as the weight of the hand. The deforming muscular and soft-tissue injuries that are associated with this fracture cannot be controlled with plaster immobilization.
Boxers and other combat athletes routinely use hand wraps and boxing gloves to help stabilize the hand, greatly reducing pain and risk of injury during impact. Proper punching form is the most important factor to prevent this type of fracture.
Stenosing tenosynovitis is most commonly caused by overuse from chronic repetitive activities using the hand or the involved finger. Examples include work activities (e.g., computer use, materials handling) or recreational activities (e.g., knitting, golf, racket sports). Carpenters who use hammers suffer from this as well as those who continuously grip wood or other materials when cutting them due to having to use your hands as a clamp to hold things in place.
Primary stenosing tenosynovitis can be idiopathic, occurring in middle age women more frequently than in men, but can present also in infancy.
Secondary stenosing tenosynovitis can be caused by disease or entities that cause connective tissue disorders including the following:
- Rheumatoid arthritis and psoriatic arthritis—therefore the clinician must assess the hands for rheumatologic deformities.
- Gout
- Diabetes mellitus
- Amyloidosis
- Systemic lupus erythematosus
Others causes may include the following:
- Direct trauma to the site
- During the postpartum period
- Congenital
The cause of trigger finger is unclear but several causes have been proposed. It has also been called stenosing tenosynovitis (specifically "digital tenosynovitis stenosans"), but this may be a misnomer, as inflammation is not a predominant feature.
It has been speculated that repetitive forceful use of a digit leads to narrowing of the fibrous digital sheath in which it runs, but there is little scientific data to support this theory. The relationship of trigger finger to work activities is debatable and scientific evidence for and against hand use as a cause exist. While the mechanism is unclear, there is some evidence that triggering of the thumb is more likely to occur following surgery for carpal tunnel syndrome. It may also occur in rheumatoid arthritis.
Fractures of the fingers occur when the finger or hands hit a solid object. Fractures are most common at the base of the little finger (boxer's fracture).
Nerve injuries occur as a result of trauma, compression or over-stretching. Nerves send impulses to the brain about sensation and also play an important role in finger movement. When nerves are injured, one can lose ability to move fingers, lose sensation and develop a contracture. Any nerve injury of the hand can be disabling and results in loss of hand function. Thus it is vital to seek medical help as soon as possible after any hand injury.
Sprains result from forcing a joint to perform against its normal range of motion. Finger sprains occur when the ligaments which are attached to the bone are overstretched and this results in pain, swelling, and difficulty for moving the finger. Common examples of a sprain are jammed or twisted fingers. These injuries are common among ball players but can also occur in laborers and handy men. When finger sprains are not treated on time, prolonged disability can result.
A mallet finger is an extensor tendon injury at the farthest away finger joint. This results in the inability to extend the finger tip without pushing it. There is generally pain and bruising at the back side of the farthest away finger joint.
A mallet finger usually results from over bending of the finger tip. Typically this occurs when a ball hits an outstretched finger and jams it. This results in either a tear of the tendon or the tendon pulling off a bit of bone. The diagnosis is generally based on symptoms and supported by X-rays.
Treatment is generally with a splint that holds the finger straight continuously for 8 weeks. This should be begun within a week of the injury. If the finger is bent during these weeks, healing may take longer. If a large piece of bone has been torn off surgery may be recommended. Without proper treatment a permanent deformity of the finger may occur.
The Jersey Finger is a finger-related tendon injury that is common in athletics and can result in permanent loss of flexion of the end of the finger if not surgically repaired.
This injury often occurs in American football when a player grabs another player's jersey with the tips of one or more fingers while that player is pulling or running away.
Treatment is generally with a splint that holds the finger straight continuously for 8 weeks. The split may be worn for a few more weeks after this just at night. This should be begun within a week of the injury.
Surgery generally does not improve outcomes. It may be required if the finger cannot be straitened by pushing on it or the break has pulled off more than 30% of the joint surface. If the problem has been present a long time surgery may also be required. An open fracture may be another reason. Surgery will put the finger in a neutral position and drill a wire through the DIP to the PIP, forcing immobilization.
In one study, those with stage 2 of the disease were found to have a slightly increased risk of mortality, especially from cancer.
The classically used Leddy and Packer Classification classifies Jersey finger tendon injuries based on the degree of tendon injury, retraction, and presence of a concomitant fracture.
Often, surgical pins are inserted into the injured digit to stabilize the bone and tendon in their proper alignment. Post surgical complications can include infection, pin failure and nail and joint deformity. Surgery is often accompanied by a rehabilitation protocol to strengthen the injured muscle and help the patient regain as much range of motion (ROM) as possible at the affected joint. The finger may never return normal extension ROM.
Workers in certain fields are at risk of repetitive strains. Most occupational injuries are musculoskeletal disorders, and many of these are caused by cumulative trauma rather than a single event. Miners and poultry workers, for example, must make repeated motions which can cause tendon, muscular, and skeletal injuries.
Galeazzi fractures account for 3-7% of all forearm fractures. They are seen most often in males. Although Galeazzi fracture patterns are reportedly uncommon, they are estimated to account for 7% of all forearm fractures in adults. They are associated with a fall on an outstretched arm.
Swan neck deformity has many possible causes arising from the DIP, PIP, or even the MCP joints. In all cases, there is a stretching of the volar plate at the PIP joint to allow hyperextension, plus some damage to the attachment of the extensor tendon to the base of the distal phalanx that produces a hyperflexed mallet finger. Duck bill deformity is a similar condition affecting the thumb (which cannot have true swan neck deformity because it does not have enough joints).
Hammer toe most frequently results from wearing poorly fitting shoes that can force the toe into a bent position, such as excessively high heels or shoes that are too short or narrow for the foot. Having the toes bent for long periods of time can cause the muscles in them to shorten, resulting in the hammer toe deformity. This is often found in conjunction with bunions or other foot problems (e.g., a bunion can force the big toe to turn inward and push the other toes). It can also be caused by muscle, nerve, or joint damage resulting from conditions such as osteoarthritis, rheumatoid arthritis, stroke, Charcot–Marie–Tooth disease, complex regional pain syndrome or diabetes. Hammer toe can also be found in Friedreich's ataxia (GAA trinucleotide repeat).
In terms of overuse injuries a British study found that:
- 40 percent occurred in the fingers
- 16 percent in the shoulders
- 12 percent in the elbows
- 5 percent were the knees
- 5 percent back
- 4 percent wrists
One injury that tend to be very common among climbers is Carpal tunnel syndrome. It is found in about 25% of climbers.
In many cases, conservative treatment consisting of physical therapy and new shoes with soft, spacious toe boxes is enough to resolve the condition, while in more severe or longstanding cases Hammertoe Surgery may be necessary to correct the deformity. The patient's doctor may also prescribe some toe exercises that can be done at home to stretch and strengthen the muscles. For example, the individual can gently stretch the toes manually, or use the toes to pick things up off the floor. While watching television or reading, one can put a towel flat under the feet and use the toes to crumple it. The doctor can also prescribe a brace that pushes down on the toes to force them to stretch out their muscles.
Splinting for fingers.
Passive stretching and clearing the deformity.
Trigger fingers is a common disorder characterized by catching, snapping or locking of the involved finger flexor tendon, associated with dysfunction and pain. It is a sub-set of stenosing tenosynovitis.
A disparity in size between the flexor tendon and the surrounding retinacular pulley system, most commonly at the level of the first annular (A1) pulley, results in difficulty flexing or extending the finger and the "triggering" phenomenon. The label of trigger finger is used because when the finger unlocks, it pops back suddenly, as if releasing a trigger on a gun.
People with diabetes mellitus are at higher risk for any kind of peripheral neuropathy, including ulnar nerve entrapments.
Cubital tunnel syndrome is more common in people who spend long periods of time with their elbows bent, such as when holding a telephone to the head. Flexing the elbow while the arm is pressed against a hard surface, such as leaning against the edge of a table, is a significant risk factor. The use of vibrating tools at work or other causes of repetitive activities increase the risk, including throwing a baseball.
Damage to or deformity of the elbow joint increases the risk of cubital tunnel syndrome. Additionally, people who have other nerve entrapments elsewhere in the arm and shoulder are at higher risk for ulnar nerve entrapment. There is some evidence that soft tissue compression of the nerve pathway in the shoulder by a bra strap over many years can cause symptoms of ulnar neuropathy, especially in very large-breasted women.
604 injured rock climbers were prospectively evaluated from January 1998 to December 2001, due to the rapid growth of new complex finger trauma in the mid-1980s. Of the most frequent injuries, three out of four were related to the fingers: pulley injuries accounted for 20%, tendovaginitis for 7%, and joint capsular damage for 6.1%.
Orbital fractures, in general, are more prevalent in men than women. In one study in children, 81% of cases were boys (mean age 12.5 years). In another study in adults, men accounted for 72% of orbital fractures (mean age 81).
Common medical causes of blowout fracture may include:
- Direct orbital blunt injury
- Sports injury (squash ball, tennis ball etc.)
- Motor vehicle accidents