Wrist & Hand Examination

Question 1

what are the co morbidites that are important to pay attention to?

Answer 1

DM
RA
OA

Question 2

What are some common causes of radial side wrist pain?

Answer 2

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

Question 3

What are some common causes of ulnar side wrist pain?

Answer 3

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

Question 3

What are some common causes of ulnar side wrist pain?

Answer 3

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

Question 4

what is ascending lymphangitis?

Answer 4

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

Question 5

what are Kanavie’s 4 cardinal signs of flexor sheath infection?

Answer 5

Finger/hand held in slight flexion
Swelling
Tenderness over tendon sheath
Pain on passive extension

Question 6

where are some common places of infection for the hand?

Answer 6

Mid-palmar space
web space
thenar space

Question 7

what is the most common wrist fracture?

Answer 7

colles fracture

Question 8

what will the presentation of a coleus fracture be?

Answer 8

Dinner fork deformity*
Distal & dorsal wrist pain
Swelling of the wrist
Increased angulation of the distal radius
Inability to grasp objects

Question 9

what is the common cause of a smiths fracture?

Answer 9

from flexed wrist, fisted hand or direct blow to dorsal aspect of the wrist

Question 10

what is the common deformity from smiths fracture?

Answer 10

garden spade deformity

Question 11

what are some treatment option of collet & smiths fracture?

Answer 11

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

Question 12

what is the most common carpal bone fractured?

Answer 12

scaphoid

Question 13

what is the symptom of a scaphoid fracture?

Answer 13

deep, dull ache in snuff box
Mild pain aggravate with pinching & gripping
Swelling (effusion) or bruising (ecchymosis)
Pain, tenderness, & swelling in anatomic snuffbox

Question 14

what are some treatments for a scaphoid fracture?

Answer 14

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

Question 15

what is the moi of a fracture of the 5th metacarpal?

Answer 15

punching a wall

Question 16

what are signs and symptoms that indicate a lunate dislocation?

Answer 16

Swelling
Deformity (depends on amount of swelling)
Decreased ROM
X-rays→ spilled tea cup
Murphy’s sign

Question 17

what are some treatment ideas for lunate dislocation?

Answer 17

Early surgical repair to avoid complications
Following cast pin removal, begin AROM
AROM, gentle stretching, gentle strengthening

Question 18

what dislocation is indicated by a Terry Thomas Sign?

Answer 18

scapholunate dislocation

Question 19

what are some symptoms of carpal tunnel syndrome?

Answer 19

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

Question 20

when a patient presents with carpal tunnel what sensory issues will they have?

Answer 20

-Decreased or absent sensation in thumb, index finger, middle finger & lateral border of 4th

Question 21

if a pt performs the Okay sign/tear from sign how does this help differentiate AIN from CTS?

Answer 21

Tear Drop indicates AIN b/c loss of flexor policies
-Okay sign just rules out AIN

Question 22

what is the clinical predication rule for carpal tunnel syndrome?

Answer 22

-Positive Flick Sign
-Wrist ratio index > .67
-Symotoms Severity Scale > 1.9
-Age >45 y/o

Question 23

what special test can be used for Carpal tunnel syndrome?

Answer 23

Tinels Sign
Phalens Test
Reverse Phalens
Carpal Compression Test
ULNTT-A

Question 24

what is the treatment for carpal tunnel syndrome?

Answer 24

-Carpal Tunnel Release
-Assistive Technology
-Splinting
-Carpal mobilization
-Nerve gliding
-Excersise

Question 25

what position is recommended for splinting of pts with carpal tunnel syndrome?

Answer 25

neutral

Question 26

what are the special test for Wartneberg Syndrome?

Answer 26

Tinels test at radial n
Radial Nerve Tension Test

Question 27

what are the special test for ulnar nerve entrapment at guyon canal?

Answer 27

-Wartenberg’s Sign
-Forment’s Test
-Tinels Test

Question 28

what is the special test for De Quervains Tenosynovitis?

Answer 28

Finklesteins

Question 29

what is gamekeeper (skiers thumb)?

Answer 29

-Disruption of ulnar collateral ligament of the MCP jt of thumb
-Most common ligament injury in hand

Question 30

how does gamekeeper thumb occur?

Answer 30

-Secondary to traumatic event in which excessive valgus force is applied to MCP of the thumb

Question 31

what is the clinical presentation of gamekeeper thumb?

Answer 31

-Pain
-Tenderness, ecchymosis & swelling near medial MCP of thumb
-May have instability of jt & weakness with grasping objects