Finger injuries are extremely common in children of all ages. Obvious fractures are easily recognized and quickly diagnosed by appropriate X-ray examination.
Children with persistent finger injuries require careful evaluation. Children with blunt trauma to the ends of the fingers may suffer damage to the tendons, resulting in mallet finger (the tip of the finger is pointed down and cannot be brought up) or boutonniere deformity (the tip of the finger is pulled up [see Fig. 13.2]). Whenever a child suffers an injury to the end of the finger, parents should check that the child can move all of the individual parts of the finger appropriately. If a tendon is ruptured, the injury should be corrected surgically. Boutonniere deformity may also be the result of arthritis.
Young children with swollen fingers or toes without explanation are often thought to have banged or stubbed them. But if the pain or swelling persists, the child should be carefully examined for evidence of arthritis. Persistent swollen fingers (dactylitis, or "sausage digit") may be the first manifestation of serious arthritis (see Chapter 7).
Wrist injuries are common among older children engaged in vigorous sports activity. Most fractures are easily diagnosed with X-rays. One exception is fractures of the scaphoid bone, located at the center of the wrist. Fractures usually occur when a child falls hard on the outstretched hand. Although the child may complain of pain in the wrist, there is often no obvious problem. However, the pain will persist and the wrist will be tender if it is moved in the direction of the thumb or pressure is applied to the space at the base of the thumb (see Fig. 3-13). Fractures of the scaphoid often are not seen on regular X-rays unless special views are taken.
Another fracture that may not be immediately recognized is the boxer's fracture, which occurs at the first knuckle of the little finger (end of the fifth metacarpal). This fracture frequently occurs when the child strikes something hard, such as a wall or a locker. There is marked pain over the base of the finger. This fracture should be identified and properly treated, as failure to correct the injury may result in significant deformity.
Tendon irritation, sprains, and strains are uncommon in children under the age of ten except as the result of trauma. In older children, overuse injuries are common, especially with tennis and gymnastics. Children experiencing wrist pain in association with sports activities should be allowed to rest and recuperate to avoid worsening the inflammation.
Several forms of arthritis commonly begin in the wrist. The key to recognizing arthritis early lies in a careful examination. Most children with arthritis have several joints involved, whereas children with a chronic injury usually have only one involved joint.
Certain genetic conditions may initially present with complaints of hand and wrist pain without obvious explanation. Metabolic storage diseases may cause a buildup of abnormal materials that first cause pain in the hands because the wrist is a narrow space where nerves can be compressed. Although Fabry disease and mucopolysaccharidosis type I are very rare conditions, children with these diseases are often found to have been complaining of unexplained hand pain for years before the other manifestations of the diseases became obvious.
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