Hand And Wrist Pain

Question 1

What should you palpate during a hand/wrist exam?

Answer 1

Palmar fascia, DIP, MCP and PIP joints, flexor tendons, carpal bones, scaphoid, place thumb on anatomic snuff box

Question 2

What is carpal tunnel syndrome?

Answer 2

Condition that is caused by the compression of the median nerve

Question 3

What are the risk factors for carpal tunnel syndrome?

Answer 3

Multifactorial but risk factors includes obesity, hypothyroidism, DM
Repetitive movement/workplace factors, pregnancy, genetic, CT disorder, female gender higher risk

Question 4

What is the classic presentation/exam findings for carpal tunnel syndrome?

Answer 4

Pain and paresthesia along the first 3 and 1/2 digits which the distribution of along the route of the median nerve is being compressed

Question 5

What are the specialty exams for carpal tunnel syndrome?

Answer 5

Tunnels: compression of the median nerve by tapping on the nerve
Phalens: flexion of the wrist to compress the nerve

Question 6

What is De quervain tenosynovitis?

Answer 6

Recurrent inflammation of the tendon and synovial sheath covering extensor pollicis brevis and abductor pollicis longus

Question 7

What is the classic presentation/exam findings for de qeurvain tenosynovitis?

Answer 7

Radial wrist pain (over the radial styloid) at base of thumb especially with movements of the thumb

Question 8

What is the specialty exam for de quervain tenosynovitis?

Answer 8

Positive finkelstein test (good sensitivity and specificity)

Question 9

What are the causes for de quervain tenosynovitis?

Answer 9

Recurrent movements (ex. new mothers picking up their child), idiopathic

Question 10

What is the classic presentation/exam finding for trigger finger (also known as stenosing flexor tenosynovitis)?

Answer 10

Pain, locking and clicking of MCP joint
Common in the 5th and 6th decade of life
Most common on ring finger but may occur on any finger
Thickening of the flexor tendon which causes the first annular pulley to not work properly

Question 11

What are the causes of trigger finger?

Answer 11

Common, idiopathic, risk factors include diabetes, amyloidosis, RA, hypothyroidism, over use trauma, etc

Question 12

What is dupuytren’s contracture?

Answer 12

Fibrosis of the palmar fascia which causes progressive stiffening of the joint and inability to fully extend the finger

Question 13

What is the cause of dupuytren’s contracture?

Answer 13

Idiopathic, thickening of the palmar fascia due to fibroblast ic proliferation and collagen deposition

Question 14

What is the classic presentation/exam findings for dupuytren’s contracture?

Answer 14

More common in white males and presents as a thickening on the palmar surface, painful or painless
On exam cord like structures and flexed digit with palpable cord

Question 15

What is the classic presentation for a scaphoid fracture?

Answer 15

Pain on the radial aspect of the wrist and reduced grip strength after fall on outstretched hand (FOOSH)

Question 16

What are the specialty tests/exam findings for a scaphoid fracture?

Answer 16

Tenderness on anatomic snuff box is highly sensitive for this particular fracture
Tenderness with scaphoid compression and on scaphoid tubercle is also sensitive but more specific

Question 17

What is the cause of a scaphoid fracture?

Answer 17

Fall on out stretched hand which causes hyperextension of the wrist
Scaphoid has poor blood supply therefore non-union is a complication

Question 18

What is a boxer’s fracture?

Answer 18

Fracture of the metacarpal neck (usually the 5th digit but can involve the fourth)

Question 19

What is the classic presentation/exam findings of a boxer’s fracture?

Answer 19

Pain on the dorsum of the hand after direct trauma (recent fight, etc)
Swelling and bruising may be present on dorsum of the hand
Tenderness over fracture site

Question 20

What are the causes of a boxer’s fracture?

Answer 20

Caused by direct injury/trauma to the clenched fist

XR used to diagnose

Question 21

What is the classic presentation of a colle’s fracture?

Answer 21

Wrist pain with possible deformity (dinner fork deformity) but can appear normal on exam
Tenderness over fracture site on radial aspect of wrist, possibly see bruising or swelling
Seen in young pt usually due to sports injury (ex. Soccer, rugby, skiing, dancing, etc)
White female >50 yo due to increase risk of osteoporosis

Question 22

What is the cause of a colle’s fracture?

Answer 22

FOOSH with wrist in extension

Risk factor is OA in older pts

Question 23

What is rheumatoid arthritis?

Answer 23

An inflammatory poly arthritis causing deformity of the joints trough the damage of the bone and cartilage
Most commonly affects the MCP and PIP joints of the finger but can effect large and small joints

Question 24

What is the classic presentation for RA?

Answer 24

Morning stiffness, swelling and pain of the MCP and PIP, 3 or more joints affected
Deformity of the digit

Question 25

What are the causes of RA?

Answer 25

Autoimmune, unknown etiology

Test for antibodies (RF, CCP, ANA), acute phase reactants