Evaluation of the Hand and Wrist

Question 1

fingernail abnormalities

Answer 1

spoon nails - anemia, iron deficiency, diabetes, local fungal infection

Question 2

clubbed nails

Answer 2

COPD or heart defects

Question 3

Vaso-Sudo-Pilomotor and Trophic Changes

Answer 3

loss of hair
brittle nails
skin color/temp
palm hyper/hypohidrosis
skiny or dry skin

possible indications of peripheral nerve injury, peripheral vascular disease, diabetes, Raynauds, RSD-CRPS

Question 4

Osteoarthritis Enlargements

Answer 4

Bouchards nodes at PIP; Heberden’s nodes at DIP

Question 5

Swan Neck

Answer 5

MCP and DIP flexed; PIP extended
intrinsic contracture, rheumatoid arthritits, or volar plate injury

Question 6

Boutonniere

Answer 6

PIP flexed and DIP hyperextened

Question 7

Ulnar Drift

Answer 7

bowstring effect of extensor tendons overcome by weakned MCP capsuloligamentous structures in rheumatoid hands

most common in, but not limited to rheumatoid arthritic patients

Question 8

Tendon Deformities

Answer 8

Dupuytrens - palmar fascia contracture
more pronounced on ulnar side of hand
prominent in 50-70 year old men of scandinavian descent

Question 9

Tendon Deformities - Trigger Finger

Answer 9

thick flexor tendon sheath causing stenosis
tendon sticks and then suddenly lets go with an audible snap
most common in middle-aged women with rheumatoid arthritis

Question 10

Neurological-Induced Deformities

Answer 10

Claw Hand - intrinsic minus deformity secondary to loss of intrinsics and dominance of long extensors
cupping and arches lost
Often due to median & ulnar nerve injury

Question 11

Neurological-Induced Deformities :
Ape Hand

Answer 11

Median nerve palsy
thenar atrophy
unable to oppose

Question 12

Neurological-Induced Deformities :
Bishops Hand

Answer 12

Flexed 4/5th fingers with hypothenar wasting secondary to ulnar nerve palsy

Question 13

Neurological-Induced Deformities :
Wrist Drop

Answer 13

radial nerve palsy - wrist extensor paralysis