Hand and Wrist Bones, Joints and Finger Tendon and Pulley Injuries

Ian, lead physiotherapist at GB Boxing, starts with the 29 bones of the hand and wrist: phalanges, metacarpals, eight carpal bones and the radius and ulna. The count is 21 joints plus the two radioulnar joints, which matter because forearm rotation is linked to wrist pathology. For clinical reasoning Ian splits the region into the fingers, the thumb and the wrist. On the back of the finger, the central tendon inserts on the middle phalanx and the terminal tendon on the distal phalanx. A mallet finger leaves the person unable to actively extend the DIP joint, and most terminal and central tendon injuries can be managed conservatively. A flexor digitorum profundus rupture with retraction is different: it removes DIP flexion and needs surgery within about two to three weeks. Collateral ligaments and the volar plate also need checking. Pulley injuries, mostly of the A2 and A3 pulleys, are common in rock climbing, especially in the crimp grip, where a bowstring effect raises tension. Varying grips can help offload the pulleys.