Approach to Hand-Wrist Pain Flashcards
Swelling on dorsla aspect of wrist
Swelling on wrist (localized)
Bony enlargement on dorsal surfacer of DIP
Swelling on entire digit
Joint effusion/synovitis
Ganglion cyst
OA
Spondyloarthropathy
Atrophy of
Thenar eminence
Hypothenar eminence
Finger webs
Carpal tunnel
Ulnar neuropathy
Ulnar neuroapthy
Pain in anatomic snuff box
Tenderness and swelling of PIP
Tender and swelling of MCP
Nodules or bands of palmar fascia
Tenderness or cyst of flexor tnedons
Scaphoid fractures
RA
RA
Dupuytrn’s contracutre
Tirgger finger
Decrease finger flexion/extension
Decreased wrist fleion/extension
Trigger, dupuytren’s, ulnar neuropathy, RA
Wrist arthritis from RA or pseudogout
Carpal tunnel
Both flexion and extnesion of the wrist increases pressure
Pain in the median nerve distribtuon (1,2, and 3 digits and thenar atrophy in severe)
Phalen test flexes palsm at wrist which may produce pain
Tinel test - percussion on top of carpal tunnel produceing pain
Neutral wrist splinting is originial
Severe is surgery
Ulnar neuropathy at the elbow
Diminished hand adduction
Ganglion cyst
Tendon sheath herniation that contains synovial fluid from degneration of periarticular sturcture
2/3 occur in dorsum of wrist on radial side
Asymptomatic swelling
May cause nerve compression
Distal radius fracture
FOOSH
Colle’s fracture where distal fragment tilts up
In childrn- more in metaphysis
In elderly, distal are considered fragility fractures
Pain over dorsal wrist
Scaphoid fracture
FOOSH
Pain on radial wrist or proximal thumb
Tenderness in snuff box
MRI or CT if negative X ray
Immobilization for 4 weeks
Nonunion occurs if not tx right
de Quervain’s tendinopathy
inlfmmation of abductor pollicis longus and extensor pollicis brevis tendns from entrapment in styloid process of the radius
Chornic overuse from rep hand/wrist activities
pain on radial side of wrist aggravated by wirst/thumb movement
Tenderness over raidal styloid
finkelstein test 0 patient fold finers over thumb followed by ulnar devation of the wrist
Splint and NSAIDS
OA hand
CMC joint at base of the thumb aggravted by grasping, pinching, or turning a key
Dupuytren contriacture
Progressive fibrosis of the palmar fascia resulting in contractures
Painless nodularity of the palm
Inability to extend 4 and 5 digits
Cord may be palpable along the flexor tendons of the ulnar side of the palm or nodules over distal plamar crease
Flexion contractions in MCP and PIPs
Triggwr finger
Stenosing flexor tenosynovisits
Diabetes and RA
Tendon sheath becomes stenotic and catches flexor tendon when it tries to glide through
Painless catching or locking with attempted flextion
Eventually pain and loss of extnesion as welll
Some may have nodule at pbase of finger
Splint or GC
