Tendon and Ligament Injuries in the Hand

De Quervain's Syndrome

• Description: Inflammation of the first extensor compartment (includes APL and EPB tendons).
• Cause: Typically due to overuse, common in housewives during the 70s and 80s.
• Symptoms: Pain over the first compartment of the wrist.
• Diagnosis: Thumb held in the palm with ulnar deviation of the wrist causing pain.
• Treatment: Immobilization, splinting to stabilize the first compartment, task modification.

Gamekeeper's Thumb (Skier's Thumb)

• Description: Injury to the medial collateral ligament of the MCP joint.
• Cause: Rupture or sprain leading to loss of thumb stability.
• Symptoms: Instability in the thumb.
• Treatment: Surgical repair if ruptured, splinting to stabilize the MCP joint while allowing IP joint motion.

Dupuytren's Contracture

• Description: Thickening of the connective tissue in the palm, pulling the ring and little fingers down.
• Population: More common in individuals of Northern European descent.
• Symptoms: Inability to straighten affected fingers.
• Treatment: Multiple surgeries often required, high recurrence rate. Some consider amputation for improved hand function.

Trigger Finger

• Description: Finger gets stuck in a bent position, resembling pulling a trigger.
• Cause: Nodule in the flexor tendon getting stuck at the A1 pulley.
• Symptoms: Finger stuck at PIP joint.
• Treatment: Splinting to hyperextend MCP joint, steroid injections, surgical release of the A1 pulley.

Mallet Finger

• Description: DIP joint in flexion due to rupture of the terminal tendon (L band).
• Symptoms: Inability to extend the DIP joint.
• Treatment: Splinting to keep DIP in hyperextension, surgical repair if necessary.

Arthritis and Related Deformities

• Types: Osteoarthritis (degenerative), Rheumatoid arthritis (autoimmune).
• Symptoms and Deformities:
  • Swan Neck Deformity: DIP in flexion, PIP in hyperextension.
    • Cause: Dorsal subluxation of the lateral bands.
  • Boutonniere Deformity: DIP in hyperextension, PIP in flexion.
    • Cause: Volar subluxation of the lateral bands or central slip rupture.

Common Hand Fractures

• Colles' Fracture: Dorsal displacement of the distal radius from a fall on an outstretched hand.
• Smith's Fracture: Volar displacement of the distal radius.
• Bennett's Fracture: Fracture at the base of the thumb metacarpal.
• Boxer's Fracture: Fracture of the fourth and fifth metacarpals.
• Finger Fractures: Involves complex interplay of bones, tendons, and muscles, requiring comprehensive treatment.