L25 Physical Examination of the Wrist and Hand Flashcards
What are 4 things that assessment involves?
- Subjective history
- Physical examination
- Investigations review
- Outcome Measures
What are the 4 movements of the wrist?
What are 5 zones of the wrist?
- Radial dorsal Zone
- Central Dorsal Zone
- Ulnar Dorsal Zone
- Radial Volar Zone
- Ulnar Volar Zone
What are 12 observations when sitting at facing the patient in the inspection of the wrist?
- Relationship of wrist to body
- Oedema
- Normal tenodesis
- Skin:colour/moisture
- Spontaneity
- Nodules
- Hand posture
- Wounds
- Muscle atrophy
- Scars
- Gross deformity
- Sympathetic changes
What are 5 anatomical structures of the radial dorsal zone of the wrist?
- Radial styloid- End of radius (thumb long radius until a dip)
- Scaphoid
- 1st CMC jt
- grind test for OA
- Tendons – EPB, APL
- Finklestein’s
- Dorsal radial sensory n.
Where can you palpate the scaphoid (radial dorsal zone of wrist)?
- Palpate in snuff box
- Palpate volarly if concern
What should you observe for scaphoid (radial dorsal zone of wrist)?
Observe change from RD to UD
- More prominent in radial deviation than in ulnar deviation?
What should you observe for scaphoid (radial dorsal zone of wrist)?
Poor blood supply –> problems with healing
What does tenderness of scaphoid indicate (3) (radial dorsal zone of wrist)?
- fracture
- non-union
- SL instability
What are 4 features of thumb CMS Joint OA (radial dorsal zone of the wrist)?
- Common site for OA changes
- Observe for joint changes
- box sign, thumb adduction
- Palpate along line of MC until depression found.
- Early stages frequently tender on volar aspect
What is the thumb CMS grind test (radial dorsal zone of wrist)?
Done to test for OA
- Axial compression along the metacarpal onto the trapezium with rotation.
- React poorly to compression (load)
What are 2 soft tissues (radial dorsal zone of the wrist)?
- Observe first extensor compartment – ABL, EPB
- Dorsal Radial Sensory nerve
What are is De Quervain’s Tenosynovitis (radial dorsal zone of wrist)?
- EPB and APL tendons form first extensor compartment- palpate approximately 2cm proximal to radial styloid
- Resist EPB
- Resist APL
- Finkelstein’s test – thumb flexion and then wrist UD
What is the test for De Quervain’s Tenosynovitis?
- Test: thumb flexion with ulnar deviation = Stretched
- Pain indicates possible pathology
What are 4 features of the dorsal radial sensory nerve (dorsal radial zone of wrist)? What is the test? How is it done?
- Irritation is this area is called: Wartenburg’s syndrome/neuralgia
- Numbness tingling pain dorsal radial aspect of hand
- Susceptible to swelling and compressive force eg straps, tape, surgery
- On stretch in wrist flexion and UD further stretch
- Tinel’s – tape distally to proximally along pathway of nerve
What are 4 Radial Dorsal Zone Differential Diagnosis (most common to least common)?
- First CMC OA- Older and female
- De Quervain’s tenosynovitis
- Scaphoid fracture/non-union
- DRSN neuritis
What are 6 structures in the central dorsal zone of the wrist?
- Lister’s tubercle
- Dorsal rim radius
- Lunate
- Scapholunate Interval
- Dorsal wrist ganglion
- ECRL, ECRB tendons
What are 2 areas to palpate in the centreal dorsal zone of the wrist?
- Lister’s tubercle – useful landmark
- Dorsal rim radius – repetitive loading eg gymnasts wrist or acute fracture
What are 2 features the lunate in the central dorsal zone of the wrist?
- Find Lister’s tubercle move distally and ulnarly or alternatively palpate down the 3rd MC to the capitate to the lunate
- Lunate more prominent in wrist flexion
What does tenderness of lunate mean in the central dorsal zone of the wrist?
Tenderness maybe a rare condition – Kienbock’s, an avascular necrosis of the lunate