Hand and Wrist Flashcards
A 56-year-old female office assistant complains of pain in her right thumb, index and middle finger. The pain wakes her up at night and is relieved when she shakes her hand. Phalen and Tinel tests are positive. EMG and NVC show a conduction deficit in her right median nerve.
Carpal Tunnel syndrome
A 34-year-old school teacher experiences pain in her right wrist. The pain is worse when she cleans the whiteboard in her classroom. Finkelstein test is positive. No other tests were done.
de Quervain’s tenosynovitis
A 23-year-old female presents with painful joints in both of her hands with stiffness in the morning which lasts more than an hour. On examination, her PIP, MCP and wrist joints in both hands are swollen and tender. X-ray of her hands shows soft tissue swelling and juxta-articular bony erosions.
Rheumatoid arthritis
A 76-year-old grandmother slipped in the bath and injured her right wrist. On examination, there is swelling and tenderness in her right anatomical snuff box.
Scaphoid fracture
A 61-year-old cyclist complains of pain and tingling with numbness later in his left hand. This only occurs when he rides and it disappears within 20 minutes of stopping. Tapping over the base of the hypothenar eminence reproduces the pain and tingling. NVC of the left ulnar nerve shows a deficit distal to the skin crease at the wrist.
Ulnar nerve entrapment
A 72-year-old complains of pain in her left hand which is worse when she overuses it in the kitchen. When asked where the pain is, she points to the base of her left thumb. On examination, she has Heberden’s nodes and there is tenderness and swelling of the first CMC joint. X-ray of her hands shows narrowing of the first CMC joint space with subchondral sclerosis.
OA
A 33-year-old gardener complains of severe burning pain in his right hand after a trivial injury two months ago. On examination, the right hand is swollen, warm and sweaty. The skin is shiny and hairless when compared to the left hand. X-rays of both hands show generalized osteopenia only in the right hand.
Complex Regional Pain Syndrome (aka Reflex Sympathetic Dystrophy)
A 24-year-old college student was arrested for disorderly behavior and was locked in cuffs for the night. On his release, he complains of burning pain and tingling over the distal aspect of the lateral aspect of the wrist. Examination reveals decreased sensory starting over the base of the thumb and extending over the radial aspect of the dorsum of the hand. Movement of the wrist doesn’t aggravate the wrist pain and Finkelstein test is normal. No other tests done.
Cheiralgia paresthetica
A 22-year-old body builder has been having pains in his right wrist worse with lifting weights recently. There is tenderness located approximately 4 cm proximal to his Lister’s tubercle. There is also crepitus when asked to ulnar deviate his wrist. No tests done at this time.
Intersection syndrome (Lister’s tubercle is the dorsal tubercle of the radius)
