Chapter 7: Wrist & Hand

Question 1

What is a swan neck deformity?

Answer 1

Flexion of the metacarpophalangeal and distal interphalangeal joints, but the real deformity is extension of the proximal interphalangeal joint.

Question 2

What is a boutonniere deformity?

Answer 2

Extension of the metacarpophalangeal and distal interphalangeal joints and flexion of the proximal interphalangeal joint

Is the result of the central tendinous slip of the extensor hood

Question 3

What is a mallet deformity?

Answer 3

Is the result of a rupture or avulsion of the extensor tendon.

The distal phalanx rests in a flexed position.

Question 4

What is a trigger finger deformity?

Answer 4

Is the result of a thickening of the flexor tendon sheath which causes sticking of the tendon when flexion is attempted.

Question 5

What is a bishop’s hand deformity?

Answer 5

Wasting of the hypothenar muscles of the hand, the interossei muscles, and the two lumberical muscles due to ulnar nerve palsy.

Question 6

What is a dupuytren contracture deformity?

Answer 6

Contracture of the palmar fascia. A fixed flexion deformity of the metacarpophalangeal and proximal interphalangeal joints.

Question 7

What is a volkmann’s ischemic contracture deformity?

Answer 7

Contracture deformities of the wrist, hand and fingers caused by a lack of blood flow to the forearm.

Question 8

What are the active ranges of motion for the wrist?

Answer 8

• Pronation: 85-90 degrees
• Supination: 85-90 degrees
• Abduction: 15 degrees
• Adduction: 30-45 degrees
• Flexion: 80-90 degrees
• Extension: 70-90 degrees

Question 9

What are the active ranges of motion of the fingers?

Answer 9

• Flexion: MCP; 85-90, PIP; 100-115, DIP; 80-90 degrees
• Extension: MCP; 30-45, DIP; 20 degrees
• Abduction: 20-30 degrees
• Adduction: 0 degrees
• Thumb flexion: CMC; 45-50, MCP; 50-55, IP; 85-90 degrees
• Thumb extension: IP; 0-5 degrees
• Thumb abduction: 60-70 degrees
• Thumb adduction: 30 degrees

Question 10

What are the end feels for passive ranges of motion of the wrist and fingers?

Answer 10

• Pronation/supination: tissue stretch
• Abduction/adduction: bone to bone
• Flexion/extension: tissue stretch
• Finger flexion/extension/abduction: tissue stretch
• Thumb flexion/extension: tissue stretch
• Thumb abduction/opposition: tissue stretch
• Thumb adduction: tissue approximation

Question 11

What is a cylinder grasp?

Answer 11

The thumb is used and the entire hand wraps around an object.

Question 12

What is a spherical grasp?

Answer 12

There is more opposition and the hand moves around the sphere.

Question 13

What is a hook grasp?

Answer 13

All of the second and third fingers are used as a hook controlled by the forearm flexors and extensors. The thumb is not involved.

Question 14

What is the lateral prehension grasp?

Answer 14

The thumb and lateral side of the index finger come into contact. No opposition is needed.

Question 15

What is the Murphy’s sign?

Answer 15

Tests for a lunate dislocation.

The patient makes a fist.

The test is positive if the head of the third metacarpal is level with the second and fourth metacarpals

Question 16

What is the Finkelstein test?

Answer 16

Tests for the presence of Quervain of Hoffmann disease, a paratenonitis in the thumb.

The patient makes a fist with the thumb inside the fingers. The examiner stabilizes the forearm and abducts the wrist.

The test is positive if there is any pain over the abductor pollicis longus and extensor pollicis brevis tendons.

Question 17

What is the Phalen’s test?

Answer 17

Tests for carpal tunnel syndrome.

The patients wrists are flexed together (backs of the hands together) and held for 1 minute.

The test is positive if there is any tingling in the thumb, index finger, middle finger and half of the ring finger.

Question 18

What is the Tinel’s sign?

Answer 18

Tests for carpal tunnel syndrome.

The examiner taps over the carpal tunnel syndrome.

The test is positive if there is any tingling or paresthesis into the thumb, index finger and the middle and lateral half of the ring finger.

Question 19

What is the Allen’s test?

Answer 19

Tests which artery provides the major blood supply to the hand.

The patient is asked to open and close the hand several times as quickly as possible and then squeeze the hand tightly. Compress the radial and ulnar arteries. Once the patient opens the hand release one artery at a time.

The test is positive when the hand flushes.