LECTURE 14B: WRIST/HAND EVAL AND EXAM Flashcards
wrist and hand eval: assessing above and below?
wrist: elbow and hand
hand: elbow, and wrist
probably need to assess spine and elbow (double crush)
complexity, dexterity of wrist and hand allows for UE versatility
works most often in conjunction with elbow/forearm complex
patient history: what should you for sure ask?
hand dominance
sport or job?
common complaints for patient history: wrist and hand involvement
Unable to turn doorknob or key in ignition
Difficulty or pain w/ pushing and pulling activities
i.e opening & closing doors
Restricted ability to grasp objects most common complaint**
Restricted ability to use hand for personal grooming, etc
Difficulty or pain w/ pushing self up from chair
Unable to carry objects / frequently drop objects
carpal tunnel: stress? diabetes? etc.
definitely want to check yellow flags via _ and _
PHQ-2
OSPRO-YF
patient health questionaire PHQ-2
what are the 2 questions
Over the past 2 weeks, how often have you had little interest or pleasure in doing things?
Over the past 2 weeks, how often have you felt down, depressed or hopeless?
systems review of wrist hand is same as elbow. What does it include
history and trauma is HUGE
traumatic wrist injury: usually fracture what?
distal radius
Colles: extension fracture with dorsal displacement, SHORTENED FOREARM
FOOSH with fractured distal radius. What is most common?
Colles’ fracture with dorsal displacement, results in shortened forearm
MOST COMMONLY FRACTURED CARPAL BONE
scaphoid 70%
***thumb function!
FOOSH MOI
pain in snuffbox
negative x ray fresh after injury
still pain 2 weeks after injury
scaphoid fracture
*commonly missed until they start to heal
treatment for scaphoid fracture
cast 6-8 weeks, surgical pining
healing time for scaphoid fracture
healing time: 8 weeks-4 months or more bc POOR BLOOD FLOW
wrist pain on ulnar side with gripping
TTP over hamate
pain with resisted 4th/5th finger flexion
hook of hamate fracture
MOI of hook of hamate fracture
stress fx from repetitive torque stresses in bat, racket, club type sports
MOI of TFCC tears
axial loading
ulnar deviation motions/distraction of wrist
volkmann’s ischemic contracture is a medical
medical emergency!!!!!!
MOI: MAJOR CRUSH TRAUMA causing within 1-2 hours
1. lack of BF to forearm
2. compartment syndrome
3. prolonged lack of BF causing shortened, contracted positions, injury to mm and nerves
flexion contractures in wrist, hand, fingers
1st CMC OA
CPR
- hand pain or stiffness
- hard tissue enlargement of 2+/10 joints
- less than 3 swollen MCPs (if yes, prob RA)
- hard tissue enlargment of 2+ DIP joints
- deformity of 2+ selected joints
de Quervain’s Tenosynovitis is inflammation of synovial sheath around what 2 tendons
ABD POLLICUS LONGUS
EXTENSOR POLLICUS BREVIS
MOI: de quervain’s
repetitive overuse problem
but direct trauma can cause this
lunotriquetral ligament sprain MOI
forced wrist ext, radial deviation
radioscapholunate ligament sprain MOI
MOI: FOOSH
Smith Fracture is WHAT
AKA ’reverse Colles’ fx’ of distal radius
Flexion fx w/ volar displacement
Extra-articular
way less common
what are common causes of finger and hand injuries?
*note: no matter what, UE/HAND are among **most commonly injured **sites in body
sharps
tools
machinery
hot/cold
electricity
chemicals
biological
vibration
gravity
When you have OA, what are these?
enlargement at dorsal DIP
enlargement at dorsal PIP
DIP: heberden’s nodes
PIP: bouchard’s nodes
NOT RA! MCP = RA, DIP/PIP = OA
flexion of MCP
extension of PIP
flexion of DIP
SWAN NECK
tear volar plate
everything around contracts - intrinsics
DUE TO RA or trauma
Ext of MCP and DIP w/ flex of PIP
Rupture of central tendon of extensor hood due to RA or trauma
BOUTONNIERE DEFORMITY
Thickening of flexor tendon sheath causing tendon to ‘catch’
Eventually will not extend
Common w/ RA
trigger finger
what is mallet finger and what is MOI?
- Avulsion of distal slip of extensor tendon
- MOI: forced flex of DIP: JAMMED
- ↓ DIP extension, normal PIP extension
NEED SURGERY
jersey finger is what?
grabbing injury
avulsion of FDP tendon, MOI forced extension against active flexion
typically 4th digit
ulnar drift is what? associated with what dx
ulnar deviation of digits from weakening passive structures, MOI: RA
ape hand is what?
thumb falls in line with fingers (ape), atrophy of thenar mm, unable to oppose or flex
NERVE INVOLVEMENT: median nerve palsy
boxer’s fracture: of _ and _ bone
4th and 5th MC bone
MC snaps on distal end, lose a knuckle (loss MCP height)
MOI: direct impact to MC shaft or head
What is dupuytren’s contracture
palmar fascia contraction with inger deformity in MCP and PIP joints
most often 4th and 5th digits
*diabetes, comorbidities bc connective tissue not as good
treatment for boxer’s fracture
casting, splinting
gamekeeper’s thumb is what? MOI?
sprain/tear of thumb UCL
*skier’s thumb
MOI: forced abduction with thumb hyperextension
from killing/snapping rabbit or chicken necks
most common ligament injured in hand
gamekeeper’s thumb
UCL OF THE THUMB
treatment of gamekeeper’s thumb
spica splint/cast for 6-10 weeks
What are 3 MOIs of UE peripheral nerve injuries?
- traction/stretch
- compression
- laceration
(stretch, squish, cut)
what conditions predispose a nerve to damage?
- Diabetes
- metabolic conditions
- autoimmune diseases (RA, sjogrens, etc)
- infection
- ETOH abuse
- meds/toxins
3 classifications of peripheral nerve injuries
- neurapraxia –> transient block, nondegenerative sunderland type 1
- **axonotmesis **–> lesion in continuity, degenerative
- neurotmesis –> nerve damage, degenerative with poorer outcomes
neuropraxia: traffic jam with block
axonotmesis is…
nerve with block, now other side of nerve is starting to damage
2-4…NERVE DEGENERATION
neurotmesis is defined as…
complete severing, other side of nerve degenerates with poor outcomes
(ripped off trunk or compressed so much with no blood flow)
NERVE DAMAGE
cervical radiculopathy is defined as
damage to spinal nerve roots (C5-T1)
TOS is defined as….
Compression of neural and/or vascular structures that pass through thoracic outlet
review slides 38-42
What is the most commonly injured peripheral nerve?
radial nerve
lateral elbow pain
no numbness or tingling (no sensory)
weakness of:
1. supinator or
2. EI
3. EPL
radial tunnel syndrome
most common peripheral neuropathy in the UE
CTS!
median nerve compression in carpal tunnel
CTS Diagnosis made with what 3 things? 80% accuracy
- positive tinel’s sign
- positive phalens sign
- sensory changes in median nerve
What are the 5 areas of compression of cubital tunnel syndrome?
