5. Wrist & Hand Flashcards Preview

Physical Assessment > 5. Wrist & Hand > Flashcards

Flashcards in 5. Wrist & Hand Deck (50):
1

CMC

Carpometacarpal joint; thumb joint; saddle-joint

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MCP

Metacarpal-phalangeal joints; Collateral ligaments; knuckles

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IP

Interphalangeal joints; hinge joints; collateral ligaments; thumb = 1 joint; Digits 2-5 have PIP & DIP

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Ulnar n.

Travels between pisiform & hamate; Peripheral nerve innervation palmar and dorsal surface of hand 1/2 of 4th digit & all of 5th

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Median n.

Travels between pisiform & scaphoid; carpal tunnel; Peripheral nerve innervating majority of palmar hand surface & dorsal tips of digits 2, 3, & 1/2 of 4.

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Radial n.

Travels under radial styloid; Innervates majority of dorsal hand surface & dorsal thumb

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Radial a.

Under styloid process of radius

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Ulnar a.

BIFURCATES AROUND HAMATE

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Wrist extensors

Extensor carpi radialis (longus & brevis); Extensor carpi ulnaris

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Wrist flexors

Flexor carpi radialis; Flexor carpi ulnaris

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Ulnar deviators

Extensor carpi ulnaris; Flexor carpi ulnaris

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Radial deviators

Extensor carpi radialis; Flexor carpi radialis

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Thumb Abductor

Abductor pollicus longus (radial)

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Thumb Extensors

Extensor pollicus brevis (radial); Extensor pollicus longus (ulnar); Abductor pollicus longus (radial)

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Thumb Flexor

Flexor pollicus

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Finger flexion

Flexor digitorum superficialis & profundus

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Finger extension

Extensor digitorum; Extensor indicis

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Thenar eminence innervation

Median n.

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Hypothenar eminence innervation

Ulnar n.

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Carpal Tunnel Syndrome Tests

Tinel sign; Phalan's; Reverse Phalan's

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Finkelstein's Test

Test for DeQuevain's Disease; patient makes fist around thumb and actively ulnar deviates; (+) = pain at thumb extensors/abductors

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DeQuevain's Disease

Tenosynovitis of abductor pollicus longus & extensor pollicus brevis

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Allen Test

Test for patency of ulnar and radial aa.

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Wrist sprains - Mechanism

Falling, forced hyperextension or hyperflexion

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Scaphoid

Most commonly fractured carpal; forced hyperextension from fall

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Boxer's Fracture

Fx of shaft of 5th MC often from wall punch

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Colles' Fracture

Ben's fracture; Distal complete fx of radius; Bones drop inferiorly; Unable to actively supinate

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Most commonly dislocated carpal bone

Lunate

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Sign of Lunate Dislocation

3rd knuckle will ride more proximally

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Trigger Finger

Tendon nodule catches in sheeth of finger flexor tendon; Finger tends to "stick"; Palpate with active flexion & extension of phalange; sudden palpable and audible snap

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Mallet Finger

Inability to extend DIP due to rupture of extensor tendon

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Ganglion Cysts

Fluid filled cysts in tendon sheeths; Non-tender; Usually occurs around wrist extensors; COMMON IN TRUCK DRIVERS

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Tendon Sheeth Ganglion

Nodule in flexor tendon sheath; TENDER to palpation

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Gamekeeper's Thumb

Ulnar Collateral Lig. Sprain of thumb due to hyperextension; from direct blow or falling

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Skier's Thumb

Ulnar Collateral Lig. Sprain of thumb due to hyperabduction; from falling on outstretched arm while holding something like a ski pole or shovel

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Volkmann's Contracture

Flexion contracture of elbow & wrist; WRIST EXTENSION CAUSES FINGER FLEXION; Post fracture/dislocation/compartment syndrome

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Drop Wrist Palsy

Extensor muscles of wrist are damaged due to radial n. damage; wrist & fingers can't extend

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Claw Hand Deformity

Hyperextension of MCP; Flexion of PIP & DIP; due to MEDIAN & ULNAR NERVE PALSY

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Ape Hand Deformity

Inability to oppose or flex thumb due to MEDIAN NERVE PALSY

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Dupuytren's Contracture

Contracture of palmar fascia; FIXED FLEXION OF MCP & PIP; USUALLY 4TH AND 5TH DIGITS; skin often adheres to fascia

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Swan Neck Deformity

Flexion of MCP; Ext of PIP; Flexion of DIP; frequently caused by RA

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Boutonniere Deformity

Extension of MCP; Flexion of PIP; Extension of DIP; Usually due to tendon rupture

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Deformities specific to Osteoarthritis

Bouchard's nodes; Heberden's nodes

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Bouchard's Nodes

At PIP joint; dorsal surface

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Heberden's Nodes

At DIP joint; dorsal surface

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Rheumatoid Arthritis

Ulnar deviation of MCP joints only; Flexion of PIP

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Osler's Nodes

Small, tender nodes in finger pads indicative of bacterial endocarditis

48

Causes of clubbing

CHF; COPD; Lung cancer; Lung abscess

49

Cause of spoon nails

Plummer-Vinson Syndrome; also causes dysphagia

50

Subungual Hematoma

Blood accumulation under the nail; direct trauma