Sprouting Up Therapy

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July 1-31: Cord Blood Awareness Month
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July 10: Chronic Disease Awareness Day
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National Hot Dog Month
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Mallet finger
Rupture of the extensor tendon where it inserts onto the distal phalanx or avulsion fracture at proximal DIP
DIP of a digit in a flexed position, unable to extend

Swan Neck Deformity
Volar plate rupture
RA or following trauma such as fracture or dislocation
Flexion of MCP and extension @ PIP with DIP flexion
Contracture of intrinsic

Boutonniere Deformity
Rupture of central slip over PIP joint
RA or following trauma
Extension of MCP and PIP joint
Flexion with DIP joint extension

The Power of Consistency

Most people quit because they don’t see results fast enough.

Today, your effort feels heavy.
A week later, it feels easier.
A month later, it becomes a habit.
A year later, the same effort creates results that once looked impossible.

Success is rarely one giant breakthrough.
It’s thousands of small improvements stacked on top of each other until ordinary effort produces extraordinary results.

Consistency doesn’t just move you forward.
It transforms the way you move forward.

What feels difficult today may become effortless tomorrow if you keep showing up.

Nerve Palsies of the Hand

Claw Fingers
MOI: Median or ulnar nerve compromise
Hyperextension of MCPs and flexion of PIPs and DIPS
Loss of intrinsic muscle action (ulnar n) and over action of long finger extensors

Ape Hand
MOI: Median nerve compromise
Thumb falls back in line with fingers, unable to flex/oppose
Atrophy of thenar eminence, over action of thumb extensors

Papal Hand
MOI: Ulnar nerve compromise
Atrophy of hypothenar eminence
Causes of flexion of the RF and SF (4th and 5th)
Ulnar guttering, wasting of DI/PI and medial 2 lumbricals

Wrist Drop
MOI: Radial nerve compromise
Extensor muscles of wrist and supinator paralyzed
Wrist and fingers unable to extend

Dupuytren’s contracture

Most to least: Ring Finger > Small Finger > Middle Finger > Index Finger

Mechanism of Injury:
oblique retinacular ligament tightness

Signs and Symptoms:
nodule of palmar aponeurosis, contracture, bands, skin pitting, tenderness, dimpling
Grade I: Thicken nodule and a band in palmar aponeurosis. Band may progress to skin tethering, puckering or pitting
-Grade II: Peritendinous band and extension of affected finger is limited
-Grade III: Flexion contracture of MCP and PIP of affected finger(s)

Conservative Treatment:
Grade I is initially managed with observation
Corticosteroid Injection: Injection of grade I nodule can be beneficial
Collagenase Injection (Xiaflex): 2 to 3 injections may be required; softens contracture connective tissue coupled with manipulation.

Surgical Treatment:
If function is impaired, contracture is progressing, or severe deformity is,
MCP Contracture > 40 degrees or PIP contracture of 20 degrees

Ulnar collateral ligament (Gamekeeper’s thumb)

Mechanism of Injury:
hyperextension of 1st CMC

Grade I: Stretching of collagen fibers within the ligament with microscopic fiber tearing
Grade II: Further deformity of collagen fibers, with macroscopic tearing of some portion of the ligament- overall continuity remains. 15-30/35 degrees = partial tear
Grade III: Most severe of ligament injuries. Macroscopic disruption of collagen fibers that result in discontinuity of ligament. >30/35 degrees = complete tear
“Stener lesion”-ligament will not heal and nodule forms

Conservative treatment:
Grade 1 & 2-splica 4-6 weeks

Surgical treatment:
Grade 3

Scapholunate dissociation (arthritis) or fracture

Mechanism of Injury
trauma (commonly undiagnosed)
FOOSH-fall on outstretched hand
FOOSH injury with wrist in Extension/radial deviation

Signs and Symptoms
Terry Thomas sign
Fracture to proximal pole can lead to avascular necrosis secondary to poor blood supply

Conservative Treatment
Thumb spice 6-8 weeks

Surgical Treatment
Reconstruction
Partial wrist fusion
Proximal row carpectomy

Distal radius fracture

Mechanism of Injury
Athletic injury
Fragility fractures (older adults)

Collies-dorsal displacement
Smith’s-palmar displacement
Barton’s
Type I: Extra-articular-No RC or DRUJ involvement. Radius only.
Type II: Extra-articular-No RC or DRUJ Involvement. Radius and ulnar styloid fracture (Ulnar Carpal Lig)
Type III: Intra-articular-RC involved. No DRUJ involvement.
Type IV: Intra-articular-RC involved. No DRUJ involvement. Fx ulnar styloid
Type V: Intra-articular-shortening. DRUJ involved, no RC involvement.
Type VI: Intra-articular-shortening. DRUJ involved, no RC. Fx ulnar styloid
Type VII: Intra-articular-shortening. DRUJ and RC joints involved.
Type VIII: Intra-articular-shortening. DRUJ and RC joints involved with Fx of ulnar styloid
Galeazzi fracture-fracture of radius with DRUJ dislocation

Conservative Treatment
Splinting/casting
Percutaneous pin fixation
External fixation

Surgical Treatment
Internal fixation