Powerful Physical Therapy

A Broken Metacarpal – Analyze, Immobilize, Then Rehabilitate

21 February 2017 by Clifford Ramos

Each human hand has twenty-seven bones. There are a total of fifteen phalanges, each in sets of three to make up your fingers, plus your thumb. In the palm of your hand are five metacarpal bones.

The top portion of your wrist contains the remaining seven small bones called carpals. A fracture of the seven carpals is commonly designated as a broken wrist, not a broken hand.

The most common bone that breaks when the doctor says you have a broken hand is the metacarpal. Here is a description of the two most common ways a metacarpal bone is broken, plus a set of guidelines for rehabilitating a metacarpal fracture.

Broken Metacarpal

The longest and least protected of these twenty-seven bones are the metacarpals. A fractured metacarpal can occur from a direct blow to the top of the palm, or direct impact against your hand when it is made into a fist.

When the force that breaks the hand comes directly down on top, it is called a crush blow. Crush blow injuries happen to athletes when the hand is stepped on while in contact with the ground. These breaks can involve more than one metacarpal, but usually result in minimal displacement of the bone at the breaking point.

A direct blow to a doubled up fist is the most common metacarpal break, it is frequently called the 'boxers fracture'. The boxer's fracture on the other hand, can create a compound fracture situation, and if displacement is severe enough, the injury can require surgery to repair.

Immobilization

Mild breaks in a metacarpal bone, fractures that do not displace the bone, can be immobilized using a splint. The splint can be removed briefly, but caution should be exercised. Without the splint in place, even moving the fingers can aggravate the break area. Moving the wrist with the splint on will be exceedingly painful and could further damage the bone.

Breaks that are more serious, like the boxers fracture, will need to be fitted for a cast. If the force is extremely intense, surgery may be necessary to realign the broken bone, or bones. All multiple fractures involving more than one metacarpal, although rare, must have a cast applied to completely immobilize the hand.

The time that your hand must be immobilized will depend on the severity of the break, and the number of metacarpals that are fractured. Splint and cast time will be somewhere between 3 and 6 weeks depending on severity. Once you are cleared to move the hand and wrist, here are some steps to enhance your rehabilitation.

Rehabilitation

Once you have your hand removed from the splint or cast, you should immediately begin the rehab process. But remember, take your time and be patient. Your hand has been immobilized for a month to a month and a half so start slowly.

If you required surgery to mend a more serious break, follow the guidelines of your orthopedic surgeon precisely. The stiffness and degree of atrophy will be directly proportional to the severity of your break, so consult with your physician before you begin to use your hand. Here are some simple and basic movements that will help you begin to regain your flexibility.

     Wrist Rolls - Roll your hand inwardly from the wrist. Keep your fingers straight and try your best not to move your fingers at all. Keep your thumb pointed out at a 90-degree angle from the palm. Start out with 10 revolutions, and then reverse the revolutions outwardly 20 more times.

Do not overdo these exercises, but make sure you do a full revolution, point your fingers back toward your elbow on the as they cross the axis of your forearm. If you feel any excessively sharp pain at the point of break in your hand, stop and talk with your doctor, or an orthopedic specialist like those at Town Center Orthopaedic Associates, P.C.

To help these exercises be safe and provide the most benefit, a trick is to keep your elbows in tight, touching your side. To regain a balance between both your hands, make sure you exercise them both equally. Do not just focus on the injured hand.

     Finger Presses – The next most important thing to strengthen are the core muscles in the palm where you fractured the metacarpal. This exercise does not necessarily need to be done with both hands, since the one that was not broken has been getting a lot of use.

Take your fingers of the non-injured hand and lay them across the fingers on the hand you broke. Your fingers should cross at a 90-degree angle. Bring your thumb into the back of your palm facing you. Do 20 repetitions of the thumb touch.

This will begin to regain the flexibility in the thumb muscular structure. Next stage in the finger press exercise is to gradually apply pressure from the injured hand back against the fingers of the top hand. This is going to hurt slightly as you begin, so be aware there will be some discomfort in the palm of the hand you broke.

Do 20 more repetitions of this pressing action. Every third day you can add two more repetitions to each of these exercises until you build to 50 total reps for each exercise.

There are more difficult exercises you can add to rebuild the strength in your hand and your forearm. Anything more intense than these simple movements should be at the discretion of a specialist.

These two simple movements will be a great place to start your rehab. They will not compromise your healing process but will help you regain the mobility in your hand, while slowly breaking down the internal scar tissue. 

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