REIDER PART 140
130 Chapter 4 Hand and Wrist
Figurę 4-42. A and B, Long finger abduction.
A B
case of the interphalangeal joint of the thumb. Maximal tenderness on either side of the DIP joints of the fingers or the interphalangeal joint of the thumb suggests injury to the corresponding collateral ligament. Such a finding should be followed by the appropriatc stability test as described in the Manipulation section.
Figurę 4-43. FIcxion of the thumb.
Proximal Interphalangeal Joints. If a PIP joint of one
of the fingers is swollen following trauma, a similar method may be used to pinpoint the injured structurc. For example, tenderness on the dorsum of the PIP joint at the base of the middlc phalanx suggests a potential bou-tonniere injury to the insertion of the central slip of the extensor digitorum communis tendon at the base of the middle phalanx. This is an important finding to detect because partial injury to the extensor insertion can later develop into a boutonniere deformity if the joint is not properly protected. As in the DIP joints, the finding of maximal tenderness on one side of the joint or the other suggests injury to the corresponding collateral ligament. Maximal tenderness on the volar aspect of the joint suggests injury to the thick volar portion of the joint capsule known as the volar piąte. It is important to remember that the area of tenderness in any of these ligament or tendon injuries can be mimicked by a periarticular fracture. Diffuse swelling can be an indication of degenerative arthritis; if morę than one finger is involved one must consider rheumatoid arthritis. Dislocation of the joint may cause diffuse swelling with deformity. Metacarpophalangeal Joints. Despite the greater play available in the MCP joints, injury to the collateral liga-ments of these joints can occur. On palpating for tenderness of the collateral ligaments of the MCP joints of the fingers, it is important to remember that the joints are located at the level of the knuckles and not at the level of the web space. The examiner gently inserts a fingertip between the mctacarpal heads and gently palpates the side of the MCP joint to detect the tenderness of these collateral ligament injuries (Fig. 4-49A). Diffuse tenderness and
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