Wrist and Hand Pathologies Flashcards
OA - SUBJECTIVE
○ Aching pain, stiffness (worse with use, better with rest)
○ Morning stiffness <30 minutes
OA - OBJECTIVE
○ Bony enlargements (e.g. Heberden’s nodes at DIP, Bouchard’s nodes at PIP)
○ ↓ ROM (especially extension/flexion)
○ Crepitus and joint line tenderness
○ Joint deformity in chronic cases
RA - SUBJECTIVE
○ Symmetrical joint pain, stiffness >30 mins in the morning
○ Fatigue, systemic features
RA - OBJECTIVE
○ Swollen, warm joints (especially MCPs, PIPs, wrist)
○ Deformities: ulnar deviation, swan-neck, boutonnière
○ ↓ ROM, joint instability
○ Synovial thickening and tenderness
Gout - SUBJECTIVE
○ Sudden onset of intense joint pain (often nocturnal)
○ Common at the 1st MCP or wrist
Gout - OBJECTIVE
○ Red, hot, swollen joint
○ ↓ ROM due to pain
○ Tophi in chronic gout
○ Tenderness on palpation
Colles Fracture - SUBJECTIVE
Fall on outstretched hand (FOOSH), immediate pain
Colles Fracture - OBJECTIVE
○ Dorsally displaced distal radius (“dinner fork” deformity)
○ Swelling, bruising, ↓ ROM
○ Possible neurovascular compromise
Dislocations - SUBJECTIVE
○ Trauma-related pain and deformity
Dislocations - OBJECTIVE
○ Obvious joint deformity, swelling, ↓ or blocked ROM
○ Tenderness at affected joint
Carpal Tunnel Syndrome (Median Nerve) - SUBJECTIVE
○ Numbness/tingling in thumb, index, middle, radial ½ of ring finger
○ Worse at night or with repetitive use.
Carpal Tunnel Syndrome (Median Nerve) - OBJECTIVE
○ Thenar muscle wasting
○ ↓ grip strength
○ Positive Phalen’s and Tinel’s tests
○ ↓ 2-point discrimination
Claw Hand (ulnar nerve lesion) - SUBJECTIVE
○ Weak grip, difficulty with fine motor tasks
Claw Hand (Ulnar nerve lesion) - OBJECTIVE
○ MCP hyperextension + PIP/DIP flexion in 4th and 5th digits
○ Hypothenar wasting, interossei wasting
○ ↓ sensation in ulnar 1½ digits
Wrist Drop (radial nerve lesion) - SUBJECTIVE
Inability to extend wrist or fingers
Wrist Drop (radial nerve lesion) - OBJECTIVE
○ Flaccid wrist and finger extensors
○ ↓ sensation in dorsal hand/thumb area (if superficial radial nerve involved)
Trigger Finger/Thumb - SUBJECTIVE
○ Clicking, locking of finger when flexing/straightening
○ Pain at base of affected finger/thumb
Trigger Finger/Thumb - OBJECTIVE
○ Palpable nodule over flexor tendon sheath
○ Finger “catches” during movement
○ Active extension may require passive assistance
Dupuytren’s Contracture - SUBJECTIVE
Progressive loss of extension (often painless early on)
Dupuytren’s Contracture - OBJECTIVE
○ Palpable fibrous cords in palm
○ Flexion contracture of ring and little finger
○ Skin puckering over palm
Tendinopathy (e.g. De Quervain’s Tenosynovitis) - SUBJECTIVE
○ Pain at radial side of wrist, aggravated by thumb movement or lifting
Tendinopathy (e.g. De Quervain’s Tenosynovitis) - OBJECTIVE
○ Tenderness over 1st dorsal compartment (APL, EPB tendons)
○ Pain on Finkelstein’s test (ulnar deviation with thumb in fist)
○ Swelling over radial styloid
