Wrist Flashcards
Observation
Muscle wasting
*Thenar – Muscle wasting at Loaf muscles Chronic median nerve compression
*Hypothenar – Muscle wasting Chronic Ulnar nerve compression
Discoloration
*Peripheral artery disease, Diabetes, Raynaud’s syndrome, Psoriasis, Reactive arthritis
*Redness with Tenosynovitis (De Quervains)
*Puncture wounds
Bumps/Swelling
*OA, swelling at PIPs and DIPs, PIP’s (Bouchard’s nodes) and DIP’s (Heberdens nodes).
*RA, Swelling, also ulnar deviation of MCPJ’s,
*boutonniere’s deformity of the thumb/MCP’s (PIP flexed-dip extended),
*swan neck deformity of phalanges
Ganglion cyst both dorsal and volar possible
Alignment/Swelling
*Madelung deformity( condition with distal end of radius and ulnar don’t form in alignment with wrist ) Looks similar to Cole’s fracture
*Coles fracture ( Swollen anatomical snuff box, Posterior displacement distal radius dinner fork deformity)
*Smiths fracture (break to the end of radius)
*Bennet’s fracture ( Thumb fracture)
*Boxers fracture ( 3rd and 4th MCP)
*Scaphoid fracture ( most common 70%)
Lunate dislocation – Most common dislocation and can cause acute carpal tunnel symptoms
TFCC tears – Instability
Tendon ruptures - of the Flexor Digitorum Profundus and Extensor Digitorum could present with Jersey finger, Mallet finger
Trigger Finger – Stenosing Tenosynotivis (Thickening of tendon sheath, get stucks under PIP when try to extend)
Dupuytren’s contracture - Thickening in palmer flexor tendons
Ulnar Claw/ Hand of benedict – Indicates ulnar or median nerve neuropathy
Palpation
Carpals – Pisiform, Hook of hamate, Tunnel of Guyon(ulnar nerve compression site), Capitate, Trapezoid, Trapezium
Anatomical snuff box contains the scaphoid bone (most common fracture site) (Tendons for extensor pollicis longus, brevis and abductor pollicis longus, also contains radial artery). Palpate here, AVN risk.
Lunate, (most common area for instability and Kenibock’s Disease)
Triquetrum difficult to palpate
Also general carpal rows proximal to distal comparison (tfcc)
Extensor tendons (dorsal) and flexor tendons (palmers) and Metacarpals
Metacarpal joints, phalanges, Distal and Proximal Phalangeal joints (Feeling for rheumatoid nodules) (Bouchards Nodes + Heberdens nodes )
Radial Pulse
AROM/PROM
Active/Passive ROM – Good clear instructions, coach with external cues if required to get movement you want. Safe confident handling with PROM, ensure full end range on PROM, ensure stabilisation of appropriate joints
Pronation/Supination 90: With your arms flexed to 90 could you rotate your arms internally for pronation and externally for supination.
Wrist
* Flexion 70-90
* Extension 70-90
* Radial deviation 15-20
* Ulnar deviation 30-45
Finger/MCP/DIPS/PIPS
* flexion – Make a fist
* extension – Could you spread your fingers as much as possible
* Abduction – Same as finger extension
* Adduction – Could you bring your fingers together until they touch each other
Thumb
* Flexion, Extension, Abduction, Adduction,
* Opposition (could you touch the fingertips of thumb and pinky)
Wrist Movements – Flexion 70-80/Extension 70-80/Radial Deviation 15-22/ Ulnar Deviation 30-38
1st CP (Thumb) – Ab/adduction/flexion/extension/opposition
MCP’s – Flexion/extension/Abduction/Adduction
DIPS and PIPS – Flexion/Extension (inability to flex DIP – jersey finger rupture of FDP) (Inability to extend DIP – Mallet finger)
RIMS
Special tests
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