Wrist & Hand

Question 1

Bony Palpation

Answer 1

1) Radial styloid process
2) Scaphoid (Navicular)
3) Lunate
4) Lister’s tubercle (Dorsal tubercle)
5) Triquetrium
6) Pisiform
7) Trapezium
8) Trapezoid
9) Capitate
10) Hook of hamate
11) Ulnar styloid process
12) Metacarpals
13) Phalanges

Question 2

Soft Tissue Palpation

Answer 2

1) Ulnar artery
2) Radial artery
3) Palmaris longus tendon
4) Carpal tunnel region
5) Thenar eminence
6) Hypothenar eminence
7) Palmar aponeurosis
8) Tissues surrounding proximal interphalangeal joints
9) Tissues surrounding the distal interphalangeal joints
10) Distal tufts of the finger

Question 3

Range of Motion

Answer 3

Wrist flexion: 80
Wrist extension: 70
Wrist ulnar deviation: 30
Wrist radial deviation: 20
Finger abduction
Finger adduction
Thumb flexion (MCP)
Thumb extension (MCP)
Finger flexion (MCP)
Finger extension (MCP)
Finger Opposition

Question 4

Tinel Wrist Sign

Answer 4

Instruct: Patient seated with wrist supinated, examiner taps over the palmar (volar) surface of wrist. (flexor retinaculum - over carpal tunnel region)
Positive: Reproduction of pain, tenderness and/or paresthesia in the median nerve distribution area (thumb, 2nd, 3rd, and lateral 1/2 of the 4th digit)
Indicates: Median neuritis, possibly carpal tunnel syndrome

Question 5

Phalen Sign and Reverse Phalen Sign aka Prayer Sign

Answer 5

Instruct: Patient seated, examiner instructs patient to flex both wrists to maximum degree and approximate until point of pain or 60 seconds. Prayer sign= maximally extended wrist (palms together), elbows same level as shoulders for 60 seconds.
Positive: Reproduction of pain and/or paresthesia in the median nerve distribution area (1st, 2nd, 3rd, and lateral 1/2 of the 4th digit)
Indicates: Median neuritis, possibly Carpal Tunnel Syndrome

Question 6

Finkelstein Test

Answer 6

Instruct: Patient seated, examiner instructs patient to place his/her thumb across the palmar surface of the hand and make a fist. Have patient flex elbow and instruct patient to ulnar deviate his/her hand.
Positive: Pain distal to the radial styloid process
Indicates: Stenosing tenosynovitis of the abductor pollicis longus and extensor pollicis brevis tendons (DeQuervain’s Disease)

Question 7

Bunnel-Littler Test

Answer 7

Patient presents with difficulty flexing the PIP joint.
Instruct: Patient seated, examiner places MCP joint in extension and tries to flex the proximal interphalangeal joint. If no flexion is possible then there is either a joint capsule contracture or tight intrinsic muscles. To differentiate, examiner places the MCP joint in a few degrees of flexion and attempts to move proximal interphalangeal joint into flexion.
Positive: 1) Flexion of the proximal interphalangeal joint cannot be achieved.
2) Flexion of the proximal interphalangeal joint is achieved.
Indicates: 1) Joint capsul contracture
2) Tight intrinsic muscles

Question 8

Retinacular Test

Answer 8

Patient presents with difficulty flexing the DIP joint.
Instruct: Patient seated, examiner places proximal IP joint in neutral and tries to flex the distal IP joint. If no flexion is possible then there is either a joint capsule contracture or tight retinacular ligaments. To differentiate, examiner places the distal IP joint into flexion.
Positive: 1) Flexion of the distal IP joint cannot be achieved
2) Flexion of the distal IP joint is achieved.
Indicates: 1) Joint capsule contracture
2) Tight retinacular ligament

Question 9

Allen Test

Answer 9

Instruct: Patient seated, examiner instructs patient to raise his/her hand above the heart level of his/her head and to open and close his/her fist for 60 seconds. Examiner occludes both the radial and ulnar after at the wrist and then lowers the patient’s arm with the fist closed and allows the fist to rest on patient’s thigh. Examiner instructs patient tot one closed fist and release digital pressure over one artery while keeping the other artery occluded. Record the filing time, while comparing color to the other hand. Then repeat procedure for other artery.
Positive: A delay of more than 10 seconds (Evans 5 secs.) in returning a reddish color to the hand.
Indicates: Radial or ulnar artery insufficiency. The artery held (occluded) by the examiner is not the artery being tested.