Block 1_Wrist/Hand

Question 1

Finkelstein’s Test evaluates what? What would be a positive test?

Answer 1

Pathology in tendons to the pollicis. More specifically, the overlying sheath of the tendons (tenosynovium) of the extensor pollicis brevis and abductor policies longs can become inflamed. Presentation is called de Quervain’s tenosynovitis. Pain over lateral wrist would be a positive sign.

Question 2

Tinel’s Test of the Carpal Tunnel evaluates for what? What would be a positive test?

Note: “Tinel’s Test” is tapping over any peripheral nerve.

Answer 2

Provokes peripheral nerve entrapment/impingement (median nerve) and confirms carpal tunnel syndrome. A positive sign would be abnormal sensation or pain radiating into their hand (location would be in the 1st, 2nd, 3rd, and half of the 4th digit - although may experience it in only a portion). Note: patients may present with pain in hand, wrist, or forearm.

Question 3

Phalen’s Test evaluates for what? What would be a positive test?

Answer 3

Can provoke nerve entrapment and confirm suspicion of carpal tunnel syndrome. Test would be positive if patient feels any abnormal sensation or pain radiating into hand in 1st, 2nd, 3rd, and lateral half of 4th digit. Note that patient can present with abnormal sensation or pain in forearm, wrist, or hand.

Question 4

How do you perform Finkelsein’s Test?

Answer 4

Ask patient to grasp thumb against pulm and ulnarly deviate hand. This can be performed actively or passively.

Question 5

How do you perform Tinel’s Test?

Answer 5

Patient supinates hand. Evaluator applies a tapping or percusing motion with fingers over the flexor retinaculum. Do so just medial to flexor carpi radialis tendon.

Question 6

How do you perform Phalen’s Test?

Answer 6

Patient brings arms up, flexes wrists to 90 degrees, and places the dorsum of each hand against each other. Patient holds until they feel symptoms or for 60 seconds.

Question 7

What is the order of a wrist/hand exam?

Answer 7

1. General observatory exam
2. Lesions, rashes, etc. of wrist/hand
3. Palpation (looking for TART)
   
   1. Radial/Ulnar styloid processes
   2. Proximal/distal rows of carpal bones
   3. Tendons of flexor digitorum muscles
   4. Thenar/Hypothenar eminance
   5. Carpal/Metacarpal joints
   6. Metacarpal/Phalangeal joints
   7. Interphalangeal joints (proximal, middle, distal) and proximal/distal phalanx
   8. Radial pulse (2+, regular rate/rhythm)
   9. Ulnar pulse (2+, regular rate/rhythm)
   10. Capillary refill (blanch fingernails - return of color within 2 seconds)
   11. Venous patterns (Assymtery? Problems?)
4. Sensation to light touch (peripheral nerves)
   
   1. Ulnar (anterior and posterior)
   2. Median
   3. Radial (dorsal)
5. ROM (active, passive, strength testing)
   
   1. Wrist
      
      1. Flexion
      2. Extension
      3. Adduct
      4. Abduct
   2. Fingers
      
      1. Flexion
      2. Extension
      3. Adduction
      4. Abduction
      5. Opposition
   3. NOTE: Strength testing on thumb must be separate!

Question 8

What things should you palpate in a wrist/hand exam?

Answer 8

1. Radial/Ulnar styloid processes
2. Proximal/distal rows of carpal bones
3. Tendons of flexor digitorum muscles
4. Thenar/Hypothenar eminance
5. Carpal/Metacarpal joints
6. Metacarpal/Phalangeal joints
7. Interphalangeal joints (proximal, middle, distal) and proximal/distal phalanx
8. Radial pulse (2+, regular rate/rhythm)
9. Ulnar pulse (2+, regular rate/rhythm)

Capillary refill (blanch fingernails - return of color within 2 seconds)
Venous patterns (Assymtery? Problems?)

Question 9

What are the peripheral nerves of the hand/wrist?

Answer 9

• ​Ulnar (anterior and posterior)
• Median
• Radial (dorsal)

Question 10

What are the actions of the wrist/hand?

Answer 10

• Wrist
  
  • Flexion
  • Extension
  • Adduct
  • Abduct
• Fingers
  
  • Flexion
  • Extension
  • Adduction
  • Abduction
  • Opposition
  • NOTE: Strength testing on thumb must be separate!