Wrist and Hand

Question 1

Wrist Bony Palpation

Answer 1

radial styloid process scaphoid (navicular) Lister’s tubercle (dorsal tubercle) lunate capitate ulnar styloid process triquetrium pisiform hook of hamate trapezium trapezoid metacarpals phalanges

Question 2

Wrist Soft Tissue Palpation

Answer 2

radial artery ulnar artery palmaris longus tendon thenar eminence hypothenar eminence palmar aponeurosis carpal tunnel region tissues surrounding proximal interphalangeal joints tissues surrounding distal interphalangeal joints

Question 3

Tinel Wrist Sign

Answer 3

* Introduce patient to reflex hammer, ask permission to proceed ( + ) Reproduction of pain, tenderness and/or paresthesia in the median nerve distrubution area (thumb, 2nd, 3rd, and lateral half of the 4th digit) ( i ) Median neuritis, possibly Carpal Tunnel Syndrome

Question 4

Phalen Sign

Answer 4

“Patient would hold this position for one minute or to the point of pain. 58, 59, 60… relax.” ( + ) Reproduction of pain and/or paresthesia in the median nerve distribution area (thumb, 2nd, 3rd, and the lateral half of the 4th digit) ( i ) Median neuritis, possibly Carpal Tunnel Syndrome

Question 5

Reverse Phalen Sign (Prayer Sign)

Answer 5

“Patient would hold this position for one minute or to the point of pain. 58, 59, 60… relax.” ( + ) Reproduction of pain and/or paresthesia in the median nerve distribution area (thumb, 2nd, 3rd, and the lateral half of the 4th digit) ( i ) Median neuritis, possibly Carpal Tunnel Syndrome

Question 6

Finkelstein Test

Answer 6

( + ) Pain distal to the radial styloid process ( i ) Stenosing tenosynovitis of the abductor pollicis longus and extensor pollicis brevis tendons (DeQuervain’s Disease)

Question 7

Allen Test

Answer 7

( + ) A delay of more than 10 seconds (Evan’s says 5 seconds) in returning a reddish color to the hand ( i ) Radial or Ulnar artery insufficiency. The artery held (occluded) by the examiner is not the artery being tested

Question 8

Bunnel-Littler Test

Answer 8

a. ( + ) Flexion of the proximal interphalangeal joint cannot be achieved a. ( i ) Joint capsule contracture - - - - - - - - - - - b. ( + ) Flexion of the proximal interphalangeal joint is achieved b. ( i ) Tight intrinsic muscles

Question 9

Retinacular Test

Answer 9

a. ( + ) Flexion of the proximal interphalangeal joint cannot be achieved a. ( i ) Joint capsule contracture - - - - - - - - - - - b. ( + ) Flexion of the proximal interphalangeal joint is achieved b. ( i ) Tight retinacular ligament

Question 10

Range of Motion

Answer 10

Wrist flexion 80° Wrist extension 70° Wrist ulnar deviation 30° Wrist radial deviation 20° Finger flexion Finger extension Finger abduction Finger adduction Thumb flexion Thumb extension Finger opposition