Hand And Wrist

Question 1

What is the capsular pattern for the wrist?

Answer 1

Flexion + extension equally

Question 2

What can refer pain to the hand and wrist?

Answer 2

Cervical spine
Shoulder (rotator cuff)
Elbow (Cubital tunnel)

Question 3

What are you looking for in a specific hand exam?

Answer 3

Cyanosis 
Jaundice 
Osteoarthritis 
Rheumatoid arthritis 
Dupytrens contracture 
Trigger finger
Xanthoma 
Leukonychia (white nails)
Koilonychia (spooning)
Onycholysis (separation of nail)
Clubbing (hear disease lungs liver)
Splinter haemorrhages (endocarditis) 
Pitting (psoriasis)

Question 4

What is located in the anatomical snuff box?

Answer 4

Radial artery
Radial styloid process
Scaphoid + trapezium
Radial artery

Question 5

What tendons make up the anatomical snuff box?

Answer 5

Extensor pollicis longus (medial)
Extensor pollicis brevis +
Abductor pollicis longus (laterally)

Question 6

Closed/Open packed position of wrist ?

Answer 6

Closed:
Full extension
Open:
Flexion with slight ulnar deviation

Question 7

Physiological/Function arches of hand?

Answer 7

Proximal transverse arch
Longitudinal arch
Distal transverse arch

Question 8

What is a tropic change, what is an example of a tropic change in the hand?

Answer 8

• a change to the superficial aspects of the hand eg, muscles, skin, fascia,
• nerve impingement due to carpel tunnel would result in scaly skin, atrophy of thenar eminence

Question 9

Static bony palpation of the hand ?

Answer 9

Dorsal surface:
-radial styloid 
-anatomical snuff box 
-scaphoid 
-Trapezium 
-Capitate 
-Lunate 
-Ulnar styloid 
-Triquetrium 
Anterior surface: 
-Pisiform 
-Hook of hamate 
\+ metacarpals, phalanges, MCP,PIP,DIP joints

Question 10

Soft tissue palpation of hand/wrist?

Answer 10

Snuff box:
-radial border - abductor pollicis longus + extensor pollicis brevis tendons 
-ulnar border - extensor pollicis longus tendon 
-deep branch of radial artery 
-tunnel of guyon (ulnar nerve/artery)
-palmaris longus 
-carpal tunnel 
Anterior hand
-palmer surface + fingers (DIPs, PIPs)

Question 11

Rang of motion for Wrist?

Answer 11

Flexion: 80-100*
Extension: 70-90*
Radial deviation: 20*
Ulnar deviation: 30*
Supination: 90*
Pronation:90*