Management of Hand I Flashcards
State 2 ways to examine the hands.
1) Blood capillary refill.
2) Assess passive and active movements.
3) Assess stability during movement.
4) Passively stress PIPJ laterally.
5) Nerve testing.
6) Range of motion.
State 2 ways the nerves are tested.
Sensation (use 2-point discrimination paperclip). Motor (radial, median and ulnar nerve).
State how the radial nerve is tested.
Ability to extend the wrist and fingers at the knuckle joint.
How is radial nerve palsy defined?
Wrist drop (no response to resistance).
State how the median nerve is defined.
Ability to bring the thumb and little finger together so they are touching.
State one way the ulnar nerve is observed.
Ability to abduct all fingers. Ability to pinch grip (froment’s sign). Check for ulnar palsy (claw hand paralysis of interosseous muscles - muscles between bone).
State 2 muscles in the forearm checked for their range in motion.
Flexor digitorum superficialis. Flexor digitorum profundus.
State common injuries experienced to hands.
Wounds. Joints. Infection. Early nerve injury. Missed hand injury in major trauma.
State 2 examples of wound injuries.
Wound injuring tendons. Bites/contaminated wounds. Finger tip injuries. Fingertips - partial amputations. Foreign bodies.
State an example of a joint injury.
Thumb ulnar collateral. Central slip. Volar plate injury. Scaphoid fracture. Scapho-lunate dislocation. Triangular fibro cartilaginous complex (TFCC). Soft tissue in joint. Missed dislocation.
Define a thumb ulnar collateral.
Injury to the ulnar collateral ligament (UCL tear) of the thumb. No resistance to the index finger.
Define a central slip.
Damage to the tendon which straightens the middle joint (proximal interphalangeal - PIP).
What is a central slip also referred to as?
Boutonniere deformity (deformed position of finger/toes).
Define a volar plate injury.
A finger bent backwards too far (hyperextended) - middle joint affected.
What is the most frequently fractured carpal bone?
Scaphoid bone (71% of fractures).
What is meant by a scapho-lunate dissociation?
Small bones in the wrist (scaphoid and lunate) move excessively in relation to one another.
What is meant by the triangular fibrocartilage complex (TFCC)?
A network of ligaments, tendons and cartilage between the ulnar and radius.
What is meant by a triangular fibrocartilage complex (TFCC) injury?
Results in pain - on ulnar side of the wrist.
State a symptom of soft tissue in the joints.
Pain. Swelling. Inflammation in tissues that surround the joint.
State the most common joints affected.
PIP. MP.
State the most common missed dislocation.
Metacarpo-phalangeal join (near knuckle).
State a symptom of a metacarpo-phalangeal joint.
Pain. Poor movement. Odd posture.
Define a felon (finger pulp infection).
Infection inside the tip of the finger (forms an enclosed pocket of pus).
Define a pulp space infection.
Infection within the fatty compartments of a finger.
Give 2 examples of hand related infections.
Pulp space infection. Finger pulp infection. Flexor sheath infection.
Define a flexor sheath infection (also called flexor tenosynovitis).
Bacterial infection in tendon sheath that surrounds tendons in palm and inside fingers.
What does a flexor sheath infection result in?
Kanavel’s Cardinal signs.
State 2 aspects of Kanavel’s Cardinal signs.
Finger in slight flexion. Swelling over affected tendon. Tenderness over affected tendon. Pain in extension of affected finger.
