Wrist & Hand Examination Flashcards
what are the co morbidites that are important to pay attention to?
DM
RA
OA
What are some common causes of radial side wrist pain?
De Quervain’s tenosynovitis
Thumb UCL
Arthroses: CMC, IC, RC
Fx I.e thumb, distal radius scaphoid
Ganglion cyst
Superficial radial neuritis
C6 Radiculopathy
CTS/ Median Nerve
Scapholunate Instability
What are some common causes of ulnar side wrist pain?
Instability: lunotriquetral, midcarpal
TFCC tear
FCU tendonitis
Arthritis: DRUJJ, pisotriquetral
Fracture: Hook of hamate, pisiform
Hypothenar hammer syndrome
Cervical radiculopathy (C8)
Ulnar tunnel/ Guyon’s canal
What are some common causes of ulnar side wrist pain?
Instability: lunotriquetral, midcarpal
TFCC tear
FCU tendonitis
Arthritis: DRUJJ, pisotriquetral
Fracture: Hook of hamate, pisiform
Hypothenar hammer syndrome
Cervical radiculopathy (C8)
Ulnar tunnel/ Guyon’s canal
what is ascending lymphangitis?
Inflammation of the lymphatic channels that occur as a result of infection at a distal site
Bacterial lymphangitis in severe cases can lead to bacteremia, sepsis & death
what are Kanavie’s 4 cardinal signs of flexor sheath infection?
Finger/hand held in slight flexion
Swelling
Tenderness over tendon sheath
Pain on passive extension
where are some common places of infection for the hand?
Mid-palmar space
web space
thenar space
what is the most common wrist fracture?
colles fracture
what will the presentation of a coleus fracture be?
Dinner fork deformity*
Distal & dorsal wrist pain
Swelling of the wrist
Increased angulation of the distal radius
Inability to grasp objects
what is the common cause of a smiths fracture?
from flexed wrist, fisted hand or direct blow to dorsal aspect of the wrist
what is the common deformity from smiths fracture?
garden spade deformity
what are some treatment option of collet & smiths fracture?
Precise reduction of the fracture to maintain normal length of radius
Closed reduction & casting are often chosen (both can vary)
Stable fractures in good alignment may be managed in short-arm cast
More complicated may require open reduction & external fixation
Loss of full rotation of the forearm, so once cast removed (usually 6 wks later) exercises should be prescribe to regain motions
what is the most common carpal bone fractured?
scaphoid
what is the symptom of a scaphoid fracture?
deep, dull ache in snuff box
Mild pain aggravate with pinching & gripping
Swelling (effusion) or bruising (ecchymosis)
Pain, tenderness, & swelling in anatomic snuffbox
what are some treatments for a scaphoid fracture?
If non-displaced → Thumb Spica Cast for 2 wks followed by 2-4 wks of splinting
A/PROM into limited range
Joint mobilization to address any limitation in wrist capsule vs stretching to address muscular tightness
what is the moi of a fracture of the 5th metacarpal?
punching a wall
what are signs and symptoms that indicate a lunate dislocation?
Swelling
Deformity (depends on amount of swelling)
Decreased ROM
X-rays→ spilled tea cup
Murphy’s sign
what are some treatment ideas for lunate dislocation?
Early surgical repair to avoid complications
Following cast pin removal, begin AROM
AROM, gentle stretching, gentle strengthening
what dislocation is indicated by a Terry Thomas Sign?
scapholunate dislocation
what are some symptoms of carpal tunnel syndrome?
Parathsia and/or pain in palmar surface of thumb, index, middle finger, & lateral border of 4th
Nocturnal paraesthesia
Pain at wrist
Weakness in thenar muscles
May have wasting or atrophy in thenar eminence
when a patient presents with carpal tunnel what sensory issues will they have?
-Decreased or absent sensation in thumb, index finger, middle finger & lateral border of 4th
if a pt performs the Okay sign/tear from sign how does this help differentiate AIN from CTS?
Tear Drop indicates AIN b/c loss of flexor policies
-Okay sign just rules out AIN
what is the clinical predication rule for carpal tunnel syndrome?
-Positive Flick Sign
-Wrist ratio index > .67
-Symotoms Severity Scale > 1.9
-Age >45 y/o
what special test can be used for Carpal tunnel syndrome?
Tinels Sign
Phalens Test
Reverse Phalens
Carpal Compression Test
ULNTT-A
