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MSK 1 > Wrist & Hand Examination > Flashcards

Wrist & Hand Examination Flashcards

1
Q

Swan neck (reasons why it happens and description)

A
  • RA, trauma

- PIP flexion, DIP hyperextension

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2
Q

boutonniere deformity (reasons why it happens and description)

A
  • RA, trauma

- PIP flexion

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3
Q

claw-hand (reasons why it happens and description)

A
  • ulnar nerve palsy (usually)

- “clawing in” of 4th and 5th digits

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4
Q

trigger finger (reasons why it happens and description)

A
  • RA, diabetes
  • usually 3rd and 4th digits
  • finger will flex but must be passively extended
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5
Q

ape hand (reasons why it happens and description)

A
  • median nerve palsy

- wasting thenar & inability to oppose thumb

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6
Q

drop wrist (reasons why it happens and description)

A
  • radial nerve palsy

- cannot extend wrist

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7
Q

Z deformity of thumb (reasons why it happens and description)

A
  • heredity, arthritis

- flexed MCP, (hyper)extended IP

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8
Q

Dupuytren’s contracture (reasons why it happens and description)

A
  • heredity, metabolic changes
  • typically 4th and 5th digits
  • a condition in which there is fixed forward curvature of one or more fingers, caused by the development of a fibrous connection between the finger tendons and the skin of the palm
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9
Q

mallet finger (reasons why it happens and description)

A
  • traumatic disruption of terminal tendon from DIP
  • ruptured extensor tendon of distal phalanx
  • cannot get DIP ext
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10
Q

volkmann’s ischemic contracture (reasons why it happens and description)

A
  • neurovascular trauma, fracture

- hook-like contracture of flexor muscles

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11
Q

ulnar drift (reasons why it happens and description)

A
  • RA

- hand drifts towards ulnar side

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12
Q

Heberden nodes (reasons why it happens and description)

A
  • OA
  • palpable bony nodules on lateral and dorsal surfaces located on distal phalanx, near DIP
  • may or may not be unilateral
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13
Q

Bouchard’s nodes (reasons why it happens and description)

A
  • OA

- located around PIP

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14
Q

digits crossing over with composite flexion (reasons why it happens and description)

A
  • fracture, mal-rotation

- instead of fingers being parallel to each other they cross over

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15
Q

arches of hand

A
  1. longitudinal (down center of palm)
  2. transverse over metacarpal heads
  3. transverse over carpals
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16
Q

What is every IP capsule reinforced with?

A

-collateral ligaments

17
Q

extensor hood mechanism

A
  • extensor digitorum communis tendon and it’s connective tissue expansion
  • fibers form the tendons of the dorsal and palmar interossei & lumbricals
  • isolated contraction of the extensor digitorum (an intrinsic extensor) produces clawing of the fingers. the EDC with the interossei/lumbricals work together for PIP & DIP extension
18
Q

differential diagnosis for palpable tenderness of radial area (options of palpations at this location)

A
  1. snuffbox tenderness/edema - consider scaphoid fracture
  2. radial styloid tenderness - consider fracture, contusion, osteoarthritis
  3. 1st dorsal compartment tenderness, provoked Finkelstein test - consider de Quervain’s syndrome
  4. pain radiating into dorsal web space w/ distal radial percussion - consider superficial sensory neuritis
  5. 1st CMC pain, provoked by axial loading & rotation - consider arthritis
19
Q

differential diagnosis for palpable tenderness of ulnar area (options of palpations at this location)

A
  1. ulnar styloid tenderness - consider fracture or nonunion
  2. distal radioulnar joint pain/crepitus/prominence, provoked by compression and/or rotation - consider instability, subluxation
  3. pain distal to ulna - consider ulna-menisci-triquetral shear
  4. extensor carpi ulnaris tenderness, snapping with supination - consider tendon subluxation
20
Q

With patient making a fist, where should the fingers point?

A

-fingers should point to scaphoid & the 3rd MCP should be most prominent

21
Q

Passive accessory motion testing of wrist (types of glides)

A
  • distraction
  • posterior
  • anterior
  • radial
  • ulnar
22
Q

passive accessory motion testing of midcarpals (types of glides)

A
  • distraction
  • posterior
  • anterior
23
Q

passive accessory motion testing of carpals (types of glides)

A
  • pisiform
  • lunate
  • capitate
24
Q

passive accessory motion testing of trapeze-metacarpal (types of glides)

A
  • distraction
  • posterior
  • anterior
  • radial
  • ulnar
25
passive accessory motion testing of intermetacarpals (types of glides)
- posterior | - anterior
26
passive accessory motion testing of 1st MCP (types of glides)
- distraction - dorsal - volar
27
passive accessory motion testing of MCP 2-5 (types of glides)
- distraction - posterior - anterior - radial - ulnar
28
passive accessory motion testing IP 1-5 (types of glides)
- distraction - anterior - posterior
29
Power Grips (4 types)
1. hook grasp 2. fist grasp 3. cylindrical grasp 4. spherical grasp
30
Precision grips (3 types and descriptions)
1. three finger pinch (ex: using a pencil) - requires opposition 2. lateral pinch/prehension (ex: stabilizing key) - opposition not required 3. tip-to-tip or pulp-to-pulp pinch (ex: grasping paper clip) - fine motor with opposition
31
Special tests for scaphoid fracture/instability
1. snuffbox tenderness (palpate anatomical snuffbox) 2. supination against resistance (hold patient's hand in hand-shake position & direct patient to resist supination of forearm) 3. longitudinal compression of thumb (hold patient's thumb & apply long axis compression through metacarpal bone into scaphoid) 4. Watson Test/Scaphoid Shift Test (used to test for scaphoid instability) - pt's elbow stabilized on table with forearm in slight pronation. grasp radial side of patient's wrist w/ thumb on palmar prominence of scaphoid. With other hand, grasp patient's hand at metacarpal level to stabilize wrist. Maintain pressure on scaphoid and move patient's wrist into ulnar deviation w/ slight extension & then radial deviate with slight flexion. Release pressure on scaphoid while wrist is in radial deviation and flexion.
32
Figure-of-Eight Measurement for Assessing Edema
-place zero mark on distal aspect of ulnar styloid process. tape measure brought across ventral surface of wrist to most distal aspect of radial styloid process. then, tape is brought diagonally across dorsum of hand and over 5th MCP joint line, brought over ventral surface of MCP joints, and wrapped diagonally across dorsum to meet start of tape
33
Special tests for identifying carpal tunnel syndrome
1. Tinel's Sign (tap median N at wrist w/ fingers) 2. Phalen's Test (pt places dorsal aspects of hands together, maintaining maximal wrist flexion for 60 seconds) 3. Reverse Phalen's Test (patient places palmar aspects of hands together maintaining max wrist extension for 60 seconds) 4. Carpal Compression Test (pt seated with elbow flexed 30 degrees, forearm supinated, and wrist in neutral, place both thumbs over transverse carpal ligament just distal to flexor wrist crease and apply moderate pressure for 30 seconds) "30 for 30"
34
Special tests for de Quervain's
- tenosynovitis of abductor pollicis longus and extensor pollicis brevis 1. Finkelstein's Test (do this BILATERALLY b/c it may be tender even when tissue is normal. pt sitting. patient makes fist with thumb inside fingers. clinician stabilizes forearm and passively ulnarly deviates wrist
35
Special tests for lunate dislocation
1. Murphy's sign (have patient make a fist and check third metacarpal joint, should be higher than the 2nd and 4th metacarpals)
36
Froment's Sign description and what it tests for
- paralysis of adductor pollicis via ulnar nerve palsy | - patient attempts to grasp paper between thumb with the IP extended and lateral border of index finger
37
Allen test description and what it tests for
- radial/ulnar arterial supply - more important diagnostically than treatment reasons - pt sitting w/ elbow bent and fingers pointing toward ceiling. clinician compresses radial and ulnar arteries at wrist. patient should open and close fist quickly. clinician releases pressure on one artery and observes the filling pattern of the vessels in the palm. same repeated for other artery

MSK 1 (15 decks)

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