UPDATED Hand and Wrist

Question 1

OBSERVATION?

Answer 1

BBRSS, muscle wastage, aligment, discolorations

Question 2

OBSERVATION
Bumps?

Answer 2

• Fractures/Dislocations/Swellings - Cant be observed but can be swollen/bruised
• Scaphoid M/C carpal bone Fx in FOOSH - Can be swelling around the anatomical snuff box
• Boxers Fx in heads 3,4,5 MC d/t punching
• Ganglion cysts - soft gel-like masses often changing in sizes
• Calluses which is thick, hardened layers of skin that develop when the skin tries to protect itself against friction or pressure

Question 3

OBSERVATION
Muscle Wastage

Answer 3

• Wastage of thenar eminence muscle (LOAF Muscles)
• Hypothenar wastage in ulnar nerve pathology (at the tunnel of Guyon or maybe higher up e.g. cubital tunnel)

Question 4

OBSERVATION
Discolouration?

Answer 4

• Raynauds (autoimmune) causes changes in the colour of hands
• Fx can cause redness
• Psoriasis/Vascular disease can cause changes in the colour of hands, especially in smokers
• Diabetes can make fingers blue d/t lack of blood supply to peripheral nerves
• Burns, blisters, wounds

Question 4

OBSERVATION
RA?

Answer 4

• Multi-joint involvement - OFten bilateral with swelling at PIP, not DIPs
• Ulnar deviation of MCPs in chronic RA
• Boutonniere deformity where flexed PIP & extended DIP
• Swan neck deformity where extended PIP and flexed DIP

Question 5

PALPATION
Posterior Routine?

Answer 5

Starting at the distal radius and moving down to the bony landmark of Lister’s tubercle.

moving down the metacarpal carpal joint line checking for tone, swelling, laxity and tenderness

ANATOMICAL SNUFFBOX - resisted extension of the thumb, in the middle would be the scaphoid on palpation

Question 6

PALPATION
Anterior

Answer 6

Palpate the thenar and hypothenar eminence checking for any muscle wasting or swelling. Weakness or atrophy can indicate nerve pathology

TRAPEZIUM - Move down the thumb onto the first carpal bone and you’ll find a divit.

CAPITATE - Slide down the 3rd digit and find the divit TRAPEZOID in between Capitate and trapezium

HAMATE - Find the hook of hamate on the hypothenar side, tender to palpate

Question 7

AROM
Flexion?

Answer 7

Flexion
70-80

Question 8

AROM
Extension?

Answer 8

Extension
70-80

Question 9

AROM
Radial Deviation

Answer 9

Radial Deviation
15-25

Question 10

AROM
Ulnar Deviation

Answer 10

Ulnar Deviation
30-40

Question 11

What other planes can the hand and wrist go into?

Answer 11

Pronation and supination

Question 12

Explain the joint play

Answer 12

Long axis distraction
PA/AP glide
Side Glides Medial and Lateral

Question 13

ORTHO TESTS
Median Nerve Tests?

Answer 13

Carpal compression - compress median nerve when flexed wrist (would be hypersensitive) & look for reproduction of symptoms

Tinels Test - Lightly tap over the nerve to elicit a sensation of tingling or pins and needles

De Quervain’s Tenosynovitis Finklesteins Test - provocative test for diagnosis of De Quervain’s disease (EPB & APL tendon)

Phalens & Reverse Phalens - Tests for CTS

Question 14

Neurodynamic Nerve Tests
ULTT1?

Answer 14

Median nerve bias

Shoulder girdle depression
Shoulder abduction
Shoulder external rotation
Forearm supination
Wrist and Finger extension
Elbow extension
Cervical side flexion

Question 15

Neurodynamic Nerve Tests
ULTT2A?

Answer 15

Median, axillary, musculotendinous

Question 16

Neurodynamic Nerve Tests
Radial ULTTC

Answer 16

Depress shoulder with hip
Arm 10 degrees of abduction
Flex elbow to 90 degrees

Question 17

ULTTD

Answer 17

Ulnar Nerve

Depress shoulder
arm to 90 degrees ABduction
Pronate forearm
Extend fingers
Lateral rotation of shoulder

Can flex neck to the opposite side to add additional tension