Wrist and Hand Flashcards
CTS SE
• Pain & numbness in the median nerve distribution (half finger)
• Difficulty in manipulating small objects eg. coins, doing up buttons, sewing (ulnar nerve is more power grip)
• If advanced, may report decreased sweating in the area
• Often start with night symptoms (due to the flexed position), but
may occur at any time
• Agg: Prolonged wrist F or E; Pressure over the anterior wrist, eg. typing; Repetitive, prolonged hand activity eg. music instrument, typing; Prolonged exposure to vibration eg. drilling
• Eased by: Rest and/or shaking your hands
CTS OE
- If mild: few objective findings
- Observation: Atrophy of thenar muscles, if advanced LOAF atrophy
- Weakness of thenar muscles, if advanced(eg. When resist opponens, notice that weaker compared to other side)
- Functional tasks (involving flexion and extension, small objects)
- Positive Tinel’s
- Positive Phalen’s tests
- AROM and PROM ok
- Sensation: decreased in the distribution of the median nerve
CTS Management
• Analgesics
• Acupuncture
• TENS
(above are shown to be effective in literature)
• Intercarpal mobilisation (diminished space can be due to the carpal bones being stiff and when mobilised the space is increased)
• Splints (0-20° extension)
• Activity modification
• Avoiding end of range wrist extension and flexion
• Avoiding pressure over the anterior wrist
(above is what is common management in physiotherapy)
CTS conservative management
- NSAIDs
- Diuretics (helps when the person has a lot of swelling)
- Rest
- Ice or heat
- Massage
- Ultrasound
- Neural glides
- Intercarpal mobilisation
- Splints (0-20° extension)
- Activity modification
- Avoiding end of range wrist extension and flexion
- Avoiding pressure over the anterior wrist
CTS surgical management
• Carpal Ligament Release
De Quervain’s SE
• Localised swelling and tenderness +/- radiate distally or proximally
• Aggravated by: Activities with wide grip and resisted ulnar deviation (stretches
tendon); Wearing watches/ bracelets; Repeated thumb extension, and abduction and/or radial deviation
• Activity-dependent BUT may be worse at night with less distractions
(if inflamed)
• Eased by: Rest, ice, splinting;
If chronic, heat
De Quervain’s OE
• Observation: Local oedema • Palpation: Local tenderness and oedema • RSC: APL & EPB painful • Finkelstein’s test positive
De Quervain’s Management
- Rest (may include splinting/ taping)
- Ice or heat (chronic)
- Ultrasound (pulsed, underwater if really acute)
- Massage
- Activity modification
- Strengthening APL and EPB (eg. Gripping or rubber band type exercises)
- NSAIDs
- TENS
- Acupuncture
- Analgesics
Scaphoid # SE
• Swelling around the wrist • Pain or tenderness over the snuffbox • Mechanism of injury: FOOSH • Aggravating activity: Gripping (squeeze the area of the fracture and open out the area of the scapho-lunate ligament) • Easing activity: Rest • 24 hour pattern: depends on activity • Hx of OP, Hx of falls
Scaphoid # OE
• Pain with resisted pronation/ supination (consider how much overpressure put on with these if suspect fracture)
• Decreased ROM (especially radial deviation)
• Tenderness over the snuffbox
• X-rays (might not show up for 2-3 weeks when the calcification starts to
occur)
Scaphoid # Management
• POP if not displaced
• If displaced, or delayed union: Open
Reduction Internal Fixation with k-wire and POP
POP exercises
Colles’ # SE
- FOOSH with IR at the shoulder, extended elbow, pronated forearm & extended wrist
- Pain is local which may refer distally or proximally
Colles’ # OE
- Movement may be limited (pain or physical block)** (main finding)
- Deformation (dinner-fork)
- Aggravated by: Gripping, Pronation/ supination, Lifting, Limited ROM for flx, ext and pronation and sup** main finding
Colles # Management
- If stable: manually reduced and POP (Burks & Sueki 2010)
- If unstable: Open Reduction Internal Fixation – k-wires are removed after approximately 6-8 weeks (depending on healing)
Hand OA SE
• Pain, stiffness, crunching, thickening/inflammation (becomes inflamed if irritate)
Aggravating activities:
• Inactivity
• Lifting
• Weight-bearing (forces joints into positions that not usually in)
• Excessive movement
• Eased by
• Rest, movement, stretching, heat, massage, NSAIDs
• 24 hours: morning/evening stiffness, eased by warm shower, Depends on activities during the day
Hand OA OE
- Joint thickening
- Decreased range of motion
- Crepitus
- Joint compression
- Deformation
- Alignment assessment
- Strength tests
Hand OA Management
- Ice
- Heat
- Massage
- Joint mobilisation
- Splinting
- Home exercises
- Low-level laser
- Activity modification
- Education
Dupuytren’s Contracture: what is it?
- Fibroproliferative disease
- The fascia thickens and tightens.
- Most commonly 4th and 5th digits
Dupuytren’s Contracture SE
- Nodules in the hand
- Generally not painful
- Flexion contractures
- Difficulties with fn tasks: Washing, Dressing, Shaking hands
- May be associated with: Previous hand trauma, Diabetes mellitus, Alcoholism, Smoking, Thyroid conditions, Genetic
- More common in males than females
Dupuytren’s Contracture OE
- Firm nodules on palpation or observation
- Nodules may be tender to palpate
- Active finger extension in skin blanching
- Contractures of the PIP or MCP
Dupuytren’s Contracture Management
• Massage (deep)
• Stretches
• Splinting
• Surgery: Fasciectomy
• Relatively new treatment: Collagenase injections: injected into the fascia, then a few days later
stretched out, and released. May result in tearing of the skin.
