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Rehabilitation and Bracing of Hand &
Wrist Injuries
Jeff G. Konin, PhD, PT, ATC, FACSM, FNATA
Professor & Chair
Physical Therapy Department
University of Rhode island
High School Sports-Related Injury Surveillance Study, US, Comstock et al RIO, 2013
Competition Practice Overall
n % n % n %
51,360 6.6 49,823 8.5 101,183 7.4
There is no hand & wrist injury prevention program
There are some techniques to minimize the risk of injury
Konin JG, Kuster TJ & Miller MD, Taping, Padding & Bracing for the Shoulder Complex, in The
Athlete’s Shoulder, Wilk, Reinhold & Andrews (Ed.) ©2009
1. Dispose & absorb forces
2. Limit anatomical movement
3. Support joint structures
4. Support musculotendinous structures
5. Enhance proprioceptive feedback
6. Secure protective pads
Konin JG, Kuster TJ & Miller MD, Taping, Padding & Bracing for the Shoulder Complex, in The Athlete’s
Shoulder, Wilk, Reinhold & Andrews (Ed.) ©2009
• Does the equipment protect the area of concern appropriately?
• Can the athlete perform the skills
required for his/her sport/activity and position/role while wearing the device?
• Will the device maintain proper
anatomical alignment? • Is the device potentially hazardous or
injurious to other participants? • Is the device legal by the rules and
regulations of the sport/activity?
Kinseio Tape sued in Consumer Fraud Class Action
(Vuckovic v. KT Health Holdings Inc. et al, case number 1:15-cv-13696)
The lawsuit alleges consumer fraud, stating that while the tape claims on the package the Kinesiology Tape treats 16 specific injuries including carpal tunnel, runner’s knee, tennis
elbow, plantar fasciitis, achilles tendonitis, ankle sprains, and shin splints, there is no scientific evidence to support those claims.
Functional Position
Wrist extension 20
Ulnar deviation 10
Slight flexion MP & IP
Midrange opposition of
thumb
And then there is:
Functional Position
Konin © 2012
Extensor Tendon Integrity
Extensor Digitorum
Communis Tendon
Involves active &
passive components
Usually a result of
blunt trauma
Must stabilize in full
extension
9.9/100,000 year (Clayton
& Court-Brown, Injury 2008)
Mallet Finger
•Bony Origin
•Tendon Origin
Konin © 2012
DIP 5
Mallet Finger
PARTIAL RUPTURE OF EXTENSOR TENDONS
Konin © 2012
Extensor Tendon
Delayed Results
Boutonniere deformity
Disruption of central slip
of the extensor hood
Results from trauma, RA
Extension of DIP
Flexion of PIP
Mallet Finger Cliff Notes
Delayed treatment (2-4 wks) has similar results as acute
management (Altan et al. J Hand Surg Am 2014)
Removable orthotic splints yield greater extension lag s/p 12
wks, as does increased age and edema (Tocco et al J Hand
Ther 2013)
Stable fractures associated with mallet finger yield good results
with function, deformity, and pain conservative vs surgical
(Gurnani et al, Ned Tijdschr Geneeskd 2014)
6-8 (6 acute, 8 chronic) weeks in a splint remains treatment of
choice unless a fracture of >1/3 of joint surface (Valdes et al J
Hand Ther 2015, systematic review of 4 RTC’s)
Konin © 2012
Flexor Tendon Disruption
Mechanism of Injury
Pulling against fixed object (Jersey Finger)
Lifting with tips of finger
Laceration
Konin © 2012
Flexor Tendon Injury
Long finger flexor test
Assessment of flexor tendons
FDS vs. FDP
Digits 2-5
Involves active and passive components
Flexor Tendon Cliff Notes
Treatment of FDP ruptures is almost always surgical and
requires a reattachment (Yeh & Shin, Hand Clin 2012)
Important to differentiate FDP from FDS function in a timely
manner with a closed injury (Neumann & Leversedge, Sports
Med Arthrosc 2014)
Treatment is complicated by in-season play and sport/position
(Freilich, Clin Sports Med 2015)
As little as 30% tendon (A2 pulley) disruption can lead to
bowstringing (Leeflang & Coert, J Plast Reconstr Aesthet Surg
2014)
Konin © 2012
FOOSH fall on outstretched hand
80% of all carpal fractures (Arsaian-Werner et al, Eur J Trauma Emerg
Surg 2015)
Scaphoid Fracture Cliff Notes
Average cast time 11 wks (waist) and 14 wks (proximal pole)
union rate of 82%, and subacute scaphoid fx (within 6 months)
can heal with casting alone even if delayed dx (Grewal et al, J
Wrist Surg 2015)
Displaced fx have greater risk for non-union, conventional x-
rays not effective to determine stability (Arsaian-Werner et al,
Eur J Trauma Emerg Surg 2015)
Advanced imaging more cost-effective and better outcomes vs.
emperic casting with 2wk f/u & repeat radiography (Karl et al,
JBJS 2015)
Primary reason for delayed dx of non-unions reported 6 months later
was self-assessed dx of wrist sprain (Heidsieck et al, J Hand
Microsurg 2015)
Konin © 2012
Ligament Sprains:
Biomechanical Impact “It is only a sprain”
Konin © 2012
Ligamentous Instability
Know how to find it!
Watson Test – Stabilize radius & Ulna distally
– Dorsal/ventral glide of scaphoid
– Indicative for instability
– Watch for secondary ganglion cyst
Konin © 2012
Konin © 2012
Murphy’s Sign
Clenched fist
View dorsal side
Identify height of
metacarpal heads
Level heads indicate
lunate dissociation
Ligament Sprain Cliff Notes
A negative MRI is unable to r/o a clinically relevant
injury to the SL or LT ligament, and clinical
provocation wrist tests are of limited diagnostic
value. The gold standard wrist arthroscopy remains
the preferred diagnostic technique (Andersson et al,
Arthoscopy 2015, systematic review & meta-analysis
7 articles)
Surgical intervention for acute (within 6 wks) injuries
has significantly lower failure rate vs chronic
(Rohman et al, J Hand Surg 2014)
Konin © 2012
Dynamometer Assessment
Test bilaterally
Look for bell-shaped
curve (length-tension)
Look for reliability over
time
Konin © 2012
Thanks!
