Wrist and Hand Common Clinical Presentations Flashcards
WRIST AND HAND FRACTURES
WRIST AND HAND FRACTURES
What are some distal radius fracture examples?
- Colles Frx (outward/dorsal)
- Smith Frx (inward)
- Barton Frx (fracture line extends through radius and into joint)
- Buckle Frx (compressive fracture)
Scaphoid Fracture:
- Most common among __-__ y/o _______
- Common at _____ and proximal pole
- Common MOI: ______ in position of ______ deviation
- Recurrent vascular supply from ______ artery. Fracture of waist results in non-union common complication (proximal pole necrosis).
- 15-30 yo males
- waist
- FOOSH, radial deviation
- radial
What are the symptoms of a Scaphoid Fracture?
- deep, dull radial wrist pain
- pain with gripping/squeezing
How will a patient with a Scaphoid Fracture present during a physical examination?
- tender anatomical snuff box
- local swelling/bruising
- often not visible on x-rays directly after injury
Hook of Hamate Fracture:
- Common MOI: _________
- Be sure to check ______ nerve function!
- Consider indicators of ulnar _______ injury
- FOOSH
- ulnar
- artery
Lunate Fracture:
- Goal: _____ recognition
- _________ Disease can be a progression of lunate frx and involves __________ of the lunate. This creates a concern for _______ collapse.
- This disease has an unknown etiology but is with history of trauma. What does management of this disease look like?
- early
- Keinbock’s Disease, osteonecrosis, carpal
- Surgery or immobilization for 6-10 weeks f/b progression of ROM/resistive exercises.
INFLAMMATORY ARTHROPATHIES
INFLAMMATORY ARTHROPATHIES
What are 3 types of inflammatory arthropathies?
- Rheumatoid Arthritis
- Septic Arthritis
- Gouty Arthritis
What are some signs of RA in the hands?
- Ulnar Drift (fingers)
- Boutonneire Deformity
- Swan Neck Deformity
What is a Boutonneire Deformity and how does it present?
- Rupture of the central band, allowing the lateral bands to slip to the palmar side of the axis of rotation of the PIP.
- Provides a flexion moment at the PIP and hyperextension moment at the DIP.
What is a Swan Neck Deformity and how does it present?
- Disruption of the volar plate at the PIP, lateral bands bowstring dorsally, increasing the moment arm of the intrinsics and causing PIP extension.
- Provides a hyperextension moment at the PIP and flexion moment at the DIP.
Mallet Deformity is typically _________ and involves _______ of the DIP because of an extensor tendon rupture.
- traumatic
- flexion
WRIST AND HAND OA
WRIST AND HAND OA
Osteoarthropathy more commonly occurs at the _______ or ____.
wrist or CMC
CMC Osteoarthropathy:
- Pain at the _____ of the thumb
- Hx prior _______ possibly
- ________
- Pain ROM at end-range (multi-directional)
- Pain with resistance
- ______ > ______
- Age > ___ years more commonly
- base
- trauma
- crepitus
- women > men
- 45 y/o
Arthropathies are typically _________ and have periods of _________/__________.
- insidious
- exacerbation/remission
How will a patient with arthropathy present during a physical examination?
- deformities (also including nodules)
- tenderness to palpation of joint line
- diminished ROM
- painful/weak resistance and grip testing
- painful/hypomobile joint mobility testing
3 ways RA is managed?
Inflammatory Management -consider remission/exacerbation -thermal/cryotherapy Exercises -gripping/resistive exercises -ROM exercises Joint Protection -splinting -activity modification
DUPUYTREN CONTRACTURE AND SPRAINS
DUPUYTREN CONTRACTURE AND SPRAINS
What are the risk factors for Dupuytren Contracture?
- caucasion
- increasing age
- male (7-15x)
- alcoholism
- DM
- smoking
- hand trauma
Wrist Sprains:
- MOI: Force to wrist exceeding normal range
- Consider ______ fracture with differential
- ______ pain that resides and returns
- Swelling, ecchymosis, tenderness, pain with movements that place tensile load (stretch) on sprained structure
- carpal
- local
1st MCP Sprain:
- Also called ________ thumb.
- It involves ______ _________ ligament sprain.
- MOI: _______ moment to 1st MCP.
- local tenderness/swelling
- ulnar collateral ligament test
- Gamekeeper’s
- ulnar collateral
- valgus moment
TFCC INJURY
TFCC INJURY
Which TFCC injuries are more likely to heal, peripheral or central? Why?
Peripheral, better vascular supply
What are the common MOIs for TFCC lesions?
- FOOSH
- Repetitive pronation/supination with loading
What are the symptoms of TFCC lesions?
- medial wrist pain
- clicking/popping with wrist motions
How will a patient with a TFCC lesion present during a physical examination?
- tenderness in area of TFCC
- swelling with more acute trauma
- AROM/PROM painful/limited ulnar deviation
- pain/tenderness with mobility testing of radiocarpal joint with ulnar deviation bias
INTERCAPRAL INSTABILITY
INTERCARPAL INSTABILITY
Intercarpal instability involves the disruption of ___________ and/or __________ ligaments and independent movement of __________.
- interosseous and/or mid-carpal ligaments
- carpals
Intercarpal instability can be divided into ________ or _______ Intercalated Segment Instability.
- Dorsal Intercalated Segment Instability (DISI)
- Volar Intercalated Segment Instability (VISI)
Dorsal Intercalated Segment Instability (DISI):
- ________ extension/ ulnar deviation
- Pain/ weakness with _______
- Tenderness over _________/_________
- ________ with joint mobility testing
- FOOSH
- grasping
- scaphoid/lunate
- laxity
How does Volar Intercalated Segment Instability (VISI) present compared to DISI?
Very similar to DISI
VISI:
- ___________ dissociation
- _______ tilt of distal lunate
- lunate remains connected to scaphoid, but not ______
DISI:
- ___________ dissociation
- ________ tilt of lunate
- lunate remains connected to triquetrium, but not _______
- lunate no longer follows scaphoid into _________
- lunotriquetrium
- volar
- triquetrium
- scapholunate
- dorsal
- scaphoid
- flexion
WRIST AND HAND TENDINOPATHIES
WRIST AND HAND TENDINOPATHIES
Tendinopathies of the wrist are typically _________ onset with a ___________ MOI.
- insidious
- microtrauma
How will a patient with tendinopathy present during a physical examination?
- tender locally
- painful with tensile loading: PROM/AROM and resistive testing
- possibly palpable thickening of tenosynovium
- crepitus with tendon moving through tendon sheath
- What is a Trigger Finger?
- Where is it most common?
- Enlargement of tendon/pulley affecting tendon as it pistons through A1 pulley.
- Occurs typically at the MC head, most commonly the 3rd digit.
What are the risk factors for Trigger Finger?
- DM
- young children
- menopausal women
- RA
What are the symptoms of Trigger Finger?
- painful snapping at MCP area during flexion/extension motions of fingers
- limited/painful finger motion
- crepitus with motion (palpable vs. auditory)
What is De Quervain’s Tenosynovities (DQT)?
Disorder involving the tendons of the abductor pollicis longus (APL) and extensor pollicis brevis (EPB) tendons. Thickening of the soft tissue structures surrounding theses tendons resulting in impaired tendon gliding.
- Does De Quervain’s Tenosynovitis (DQT) have an active inflammatory process?
- What is the prevalence in men and women?
- No
- Men = 0.5-0.7%, Women = 1.3-2.1%
What are the risk factors for DQT?
- female
- work-related injury
- computer users who use a mouse or trackball
- text messaging
- repetitive fine-motor task (typing)
How will a patient with DQT present during a physical examination?
- local tenderness
- painful ROM that places tensile load on APL and EPB
- Finkelstein’s Test
- painful resistance testing APL and EPB
- What is a Ganglia (Bible Cyst)?
- Where is it most common?
- Thin walled cyst over joint capsule/tendon sheath filled with mucoid hyaluronic acid.
- Common in anterior/posterior wrist and fingers.
A Ganglia can have possible compression on what nerves?
median and ulnar
How will a patient with Ganglia present?
- may or may not be painful
- ache with flexion/extension of joint
