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Symptoms of gamekeeper's thumb are instability of the MCP joint of the thumb, accompanied by pain and weakness of the pinch grasp. The severity of the symptoms are related to the extent of the initial tear of the UCL (in the case of Skier's thumb), or how long the injury has been allowed to progress (in the case of gamekeeper's thumb).
Characteristic signs include pain, swelling, and ecchymosis around the thenar eminence, and especially over the MCP joint of the thumb. Physical examination demonstrates instability of the MCP joint of the thumb.
The patient will often manifest a weakened ability to grasp objects or perform such tasks as tying shoes and tearing a piece of paper. Other complaints include intense pain experienced upon catching the thumb on an object, such as when reaching into a pants pocket.
People usually present with a history of an injury and localized pain. There is often a deformity in the wrist with associated swelling. Numbness of the hand can occur because of compression on the median nerve across the wrist (carpal tunnel syndrome). The wrist deformity often limits motion of the fingers.
A sprain is a type of acute injury which results from the stretching or tearing of a ligament. Depending on the severity of the sprain, the movement on the joint can be compromised since ligaments aid in the stability and support of joints. Sprains are commonly seen in vulnerable areas such as the wrists, knees, and ankles. They can occur from movements such as falling on an outstretched hand, or a twisting of the ankle or foot.
The severity of a sprain can also be classified:
Grade 1: Only some of the fibers in the ligament are torn, and the injured site is moderately painful and swollen. Function in the joint will be unaffected for the most part.
Grade 2: Many of the ligament fibers are torn, and pain and swelling is moderate. The functionality of the joint is compromised.
Grade 3: The soft tissue is completely torn, and functionality and strength on the joint is completely compromised. In most cases, surgery is needed to repair the damage.
Swelling, deformity, tenderness and loss of wrist motion are normal features on examination of a person with a distal radius fracture. Examination should rule out a skin wound which might suggest an open fracture. It is imperative to check for loss of sensation, loss of circulation to the hand, and more proximal injuries to the forearm, elbow and shoulder. The most common associated neurological finding is decreased sensation over the thenar eminence due to associated median nerve injury.
A classic "dinner fork" deformity may be seen in dorsally angulated fractures due to dorsal displacement of the carpus. The reverse deformity may be seen in volarly angulated fractures.
Tennis elbow or lateral epicondylitis is a condition in which the outer part of the elbow becomes sore and tender at the lateral epicondyle. The forearm muscles and tendons become damaged from repetitive overuse. This leads to pain and tenderness on the outside of the elbow.
Any activity, including playing tennis, that involves repetitive use of the extensor muscles of the forearm can cause acute or chronic tendonitis of the tendinous insertion of these muscles at the lateral epicondyle of the elbow. The condition is common in carpenters and laborers who swing a hammer or other tool with the forearm, and is similar to golfer's elbow, which affects the medial epicondyle on the inside of the elbow. Continuing activity after onset of the condition and avoiding mandatory rest may lead to permanent onset of pain and only treatable via surgery.
Gamekeeper's thumb (also known as skier's thumb or UCL tear) is a type of injury to the ulnar collateral ligament (UCL) of the thumb. The UCL may be torn, damaged or in some cases avulsed from its insertion site into the proximal phalanx of the thumb in the vast majority (approximately 90%) of cases. This condition is commonly observed among gamekeepers and Scottish fowl hunters, as well as athletes (such as volleyballers). It also occurs among people who sustain a fall onto an outstretched hand, frequently skiers.
A strain is a type of acute injury that occurs to the muscle or tendon. Similar to sprains, it can vary in severity, from a stretching of the muscle or tendon to a complete tear of the tendon from the muscle. Some of the most common places that strains occur are in the foot, back of the leg (hamstring), or back.
A Stener lesion is a type of traumatic injury to the thumb. It occurs when the aponeurosis of the adductor pollicis muscle becomes interposed between the ruptured ulnar collateral ligament (UCL) of the thumb and its site of insertion at the base of the proximal phalanx. No longer in contact with its insertion site, the UCL cannot spontaneously heal.
Finger injuries are usually diagnosed with x-ray and can get to be considerably painful. The majority of finger injuries can be dealt with conservative care and splints. However, if the bone presents an abnormal angularity or if it is displaced, one may need surgery and pins to hold the bones in place.
Golfer's elbow, or medial epicondylitis, is tendinosis of the medial epicondyle on the inside of the elbow. It is in some ways similar to tennis elbow, which affects the outside at the lateral epicondyle.
The anterior forearm contains several muscles that are involved with flexing the digits of the hand, and flexing and pronating the wrist. The tendons of these muscles come together in a common tendinous sheath, which originates from the medial epicondyle of the humerus at the elbow joint. In response to minor injury, or sometimes for no obvious reason at all, this point of insertion becomes inflamed.
Symptoms associated with tennis elbow include, but are not limited to: radiating pain from the outside of the elbow to the forearm and wrist, pain during extension of wrist, weakness of the forearm, a painful grip while shaking hands or torquing a doorknob, and not being able to hold relatively heavy items in the hand. The pain is similar to the condition known as "golfer's elbow", but the latter occurs at the medial side of the elbow.
Pain and soft-tissue swelling are present at the distal-third radial fracture site and at the wrist joint. This injury is confirmed on radiographic evaluation. Forearm trauma may be associated with compartment syndrome. Anterior interosseous nerve (AIN) palsy may also be present, but it is easily missed because there is no sensory component to this finding. A purely motor nerve, the AIN is a division of the median nerve. Injury to the AIN can cause paralysis of the flexor pollicis longus and flexor digitorum profundus muscles to the index finger, resulting in loss of the pinch mechanism between the thumb and index finger. Galeazzi fractures are sometimes associated with wrist drop due to injury to radial nerve, extensor tendons or muscles.
The symptoms are pain and tenderness in the specific location of the hand, which corresponds to the metacarpal bone around the knuckle. When a fracture occurs, there may be a snapping or popping sensation. There will be swelling of the hand along with discoloration or bruising in the affected area. Abrasions or lacerations of the hand are also likely to occur. The respective finger may be misaligned, and movement of that finger may be limited and painful.
As these are colloquial terms, texts and medical dictionaries do not universally agree on precise meanings. Various authorities state that a "boxer's fracture" means a break in specifically the second metacarpal bone or third metacarpal bone, with "bar room fracture" being specific to the fourth metacarpal bone or fifth metacarpal bone. Though some writers assert that boxer's fracture and bar room fracture are distinct terms representing injuries to different bones, this distinction seems to have been lost and most medical professionals now describe any metacarpal fracture as a "boxer's fracture" .
The injury can be difficult to diagnose initially as the attention is focused on the injury to the radial head, leading to the distal radio-ulnar injury being overlooked. The examination finding of tenderness of the distal radio-ulnar joint suggests an Essex-Lopresti injury in patients who have sustained high energy forearm trauma. Plain radiography shows the radial head fracture, with dorsal subluxation of the ulna often seen on lateral view of the pronated wrist.
Symptoms include:
- The child stops using the arm, which is held in extension (or slightly bent) and palm down.
- Minimal swelling.
- All movements are permitted except supination.
- Caused by longitudinal traction with the wrist in pronation, although in a series only 51% of people were reported to have this mechanism, with 22% reporting falls, and patients less than 6 months of age noted to have the injury after rolling over in bed.
The term "Colles fracture" is classically used to describe a fracture at the distal end of the radius, at its cortico-cancellous junction. However, now the term tends to be used loosely to describe any fracture of the distal radius, with or without involvement of the ulna, that has dorsal displacement of the fracture fragments. Colles himself described it as a fracture that “takes place at about an inch and a half (38mm) above the carpal extremity of the radius” and “the carpus and the base of metacarpus appears to be thrown backward”. The fracture is sometimes referred to as a "dinner fork" or "bayonet" deformity due to the shape of the resultant forearm.
Colles' fractures can be categorized according to several systems including Frykman, Gartland & Werley, Lidström, Nissen-Lie and the Older's classifications.
The most common initial symptom of wrist osteoarthritis is joint pain. The pain is brought on by activity and increases when there is activity after resting. Other signs and symptoms, as with any joint affected by osteoarthritis, include:
- Morning stiffness, which usually lasts less than 30 minutes. This is also present in patients with rheumatoid arthritis, but in those patients this typically lasts for more than 45 minutes.
- Swelling of the wrist.
- Crepitus (crackling), which is felt when the hand is moved passively.
- Joint locking, where the joint is fixed in an extended position.
- Joint instability.
These symptoms can lead to loss of function and less daily activity.
Supracondylar humerus fractures typically result from a fall on to an outstretched arm, usually leading to a forced hyperextension of the elbow. Typically, this is an isolated injury to the elbow (no injuries elsewhere). Children with this injury present with pain and swelling about the elbow. Motion at the elbow and at the wrist make the pain worse. With mild or moderate fracture displacement, there may be deformity at the elbow.
The Essex-Lopresti fracture is a fracture of the radial head with concomitant dislocation of the distal radio-ulnar joint and disruption of the interosseous membrane. The injury is named after Peter Essex-Lopresti who described it in 1951.
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.
The fracture is most commonly caused by people falling onto a hard surface and breaking their fall with outstretched hand (FOOSH)–falling with wrists flexed would lead to a Smith's fracture. Originally it was described in elderly and/or post-menopausal women. It usually occurs about three to five centimetres proximal to the radio-carpal joint with posterior and lateral displacement of the distal fragment resulting in the characteristic "dinner fork" or "bayonet" like deformity. Colles fracture is a common fracture in people with osteoporosis, second only to vertebral fractures.
A supracondylar humerus fracture is a fracture of the distal humerus just above the elbow joint. The fracture is usually transverse or oblique and above the medial and lateral condyles and epicondyles. This fracture pattern is relatively rare in adults, but is the most common type of elbow fracture in children. In children, many of these fractures are non-displaced and can be treated with casting. Some are angulated or displaced and are best treated with surgery. In children, most of these fractures can be treated effectively with expectation for full recovery. Some of these injuries can be complicated by poor healing or by associated blood vessel or nerve injuries with serious complications.
The condition is called "Golfer's Elbow" because in making a golf swing this tendon is stressed, especially if a non-overlapping (baseball style) grip is used; many people, however, who develop the condition have never handled a golf club. It is also sometimes called "Pitcher's Elbow" due to the same tendon being stressed by the throwing of objects such as a baseball, but this usage is much less frequent. Other names are "Climber's Elbow" and "Little League Elbow": all of the flexors of the fingers and the pronators of the forearm insert at the medial epicondyle of the humerus to include: pronator teres, flexor carpi radialis, flexor carpi ulnaris, flexor digitorum superficialis, and palmaris longus; making this the most common elbow injury for rock climbers, whose sport is very grip intensive. The pain is normally caused due to stress on the tendon as a result of the large amount of grip exerted by the digits and torsion of the wrist which is caused by the use and action of the cluster of muscles on the condyle of the ulna.
Epicondylitis is much more common on the lateral side of the elbow (tennis elbow), rather than the medial side. In most cases, its onset is gradual and symptoms often persist for weeks before patients seek care. In golfer's elbow, pain at the medial epicondyle is aggravated by resisted wrist flexion and pronation, which is used to aid diagnosis. On the other hand, tennis elbow is indicated by the presence of lateral epicondylar pain precipitated by resisted wrist extension. Although the condition is poorly understood at a cellular and molecular level, there are hypotheses that point to apoptosis and autophagic cell death as causes of chronic lateral epicondylitis. The cell death may decrease the muscle density and cause a snowball effect in muscle weakness - this susceptibility can compromise a muscle's ability to maintain its integrity. So athletes, like pitchers, must work on preventing this cell death via flexibility training and other preventive measures.
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.