Wrist and Hand
Core concepts
Master scaphoid fractures, perilunate and lunate injuries, scapholunate ligament tears, TFCC pathology, carpal tunnel syndrome, De Quervain tenosynovitis, trigger finger, Dupuytren contracture, mallet finger, jersey finger, boxer fractures, gamekeeper thumb, and Seymour fractures. Know the anatomy of the carpal rows, the scaphoid blood supply, and the flexor tendon zones. Examination findings such as Watson scaphoid shift, Finkelstein, Phalen, Tinel, and the ballottement test must be interpreted with mechanism and chronicity. Infection, compartment syndrome, and tendon retraction are urgent considerations in open or crush injuries.
Traps
Snuffbox tenderness after a fall is treated as a scaphoid fracture even with negative initial radiographs; repeat imaging or MRI is needed. Do not confuse a mallet finger (extensor terminal tendon) with a jersey finger (flexor digitorum profundus avulsion). A boxer fracture is a fifth metacarpal neck fracture, not a phalangeal fracture. In a child, a Seymour fracture is an open physeal injury at the distal phalanx with a subungual hematoma; it requires nail bed repair and antibiotics. De Quervain pain is radial wrist pain, not thumb base arthritis.
Worked example
A 25-year-old falls on an outstretched hand and has anatomic snuffbox tenderness with normal radiographs. Rule of thumb: immobilize and obtain repeat radiographs or MRI in 7–14 days; scaphoid fractures risk nonunion because the blood supply enters distally and flows retrograde. Do not allow early return to contact sport until union is confirmed.