Wrist/Hand Examination Flashcards
what is the resting position of the hand
slight finger flexion and slight wrist extension
what trophic changes may occur in the hand
skin texture / changes in the nails, hair or changes in ridges of hands
main difference between dupuytren’s and trigger finger contractures
dupuytren’s = permanently flexed
trigger = locking or clicking with flexion
what condition is ulnar drift commonly seen in
RA
what should the fingers point toward when flexing PIP jts
scaphoid tubercle
what is mallet finger deformity
injury to the extensor hood
causing DIP flexion
what is swan neck deformity
PIP hyperextension and DIP Flexion
what is boutonniere deformity
PIP flexion
DIP hyperextension
due to rupture of PIP central slip
explain four stage tendon glide testing?
– steps and what it tests
ability to open the hand (MP/IP extension)
hook fist - IP and DIP flexion via lumbrical muscle extensibility and FDS/FDP
straight fist - max FDS flexion
full fist - max FDP tendon gliding
wrist ROM values
flex = 80
ext = 70
radial = 20
ulnar = 30
finger ROM values
MCP Flex = 90
MCP ext = 45
PIP Flex = 100
PIP ext = 0
thumb CMC ROM values
CMC flex - 15
CMC ext - 30
CMC abd - 70
thumb MCP / ICP ROM values
MCP flex = 50
MCP ext = 0
IP flex = 80
IP ext = 20
opposition = base of 5th digit
explain the roll and slide of thumb ab/adduction
roll and slide are opposite
–> thumb on trapezium
abduction = anterior roll, posterior slide
adduction = posterior roll, anterior slide
explain the roll and slide of CMC flexion/extension
roll and slide are same direction
–> thumb on trapezium
flexion = medial roll and slide
extension = lateral roll and slide
what is the Kapandji scale? worst vs best score?
scale for measuring thumb opposition
worst = lateral border of middle phalanx of index finger
best = to most medial aspect of the distal palmar crease
how to screen for scaphoid fracture
snuffbox tenderness
likelihood ratios are out of this world
bony palpation landmarks for the wrist and hand
radial / ulnar styloid
carpal bones
metacarpals
phalanges
soft tissue palpation locations of wrist and hand
thenar/hypothenar eminence
palmar fascia
anatomical snuffbox
extensor tendon sheaths
what is the focus of special tests at the wrist and hand
to stress the ligamentous structure
to approximate and grind the joint
to stretch a tendon
occlusion of an artery
explain purpose of ballotement test
ligament laxity between lunate and triquetrum
explain ballotment’s test protocol
palpate lunate and triquetrum
move the bones in dorsal and volar directions
– looking for laxity, crepitus or reproduction of pain
explain protocol of the finkelstein test
patient to make fist with thumb tucked
stabilize forearm and deviate wrist ulnarly
– looking for reproduction of pain over APL and EPB at wrist
explain the grind test protocol
stabilization of trapezium
find CMC joint line and compress first metacarpal into trapezium
– looking for reproduction of symptoms / indicate CMC OA
explain watson scaphoid test protocol
place wrist into slight extension and ulnar deviation
stabilize scaphoid with thumb/index
move wrist into flexion and radial deviation
release scaphoid
–feeling for clunk or reproduction of pain
explain protocol for press test
have patient seated in chair with arm rests
ask patient to push off on arm rests
suspend their body using only their hands
- positive is reproduction of ulnar sided wrist pain
what are the dexterity and functional tests that can be used
functional dexterity test
nine hole peg test
purdue peg board
jebsen-taylor functional test
grip strength / pinch grip
T-FAST
what could be an objective measure if compartment syndrome was suspected
lack of pulses via Allen’s test
what is a colles fx? what position would someone be in during impact?
distal radius fracture when falling in stereotypical FOOSH position
- wrist extended
which direction would the radius be displaced during a Colles fx
posteriorly
what is a smith fx? what position would someone be in during impact?
distal radius fracture with the wrist flexed
