Hand and Wrist

Question 1

What are observations of the hand/wrist?

Answer 1

Bumps/Bruises/Redness/Scars/Swelling/Muscle Wasting/Discoloration/Alignment

Question 2

Why would there be some abnormal observations on the hand/wrist?

Answer 2

Muscles wasting at thenar/hypothenar (median nerve compression)
Discoloration – Peripheral artery disease, Diabetes, Raynaud’s syndrome
Bumps -OA, swelling at MCP’s, PIPjs (Bouchard’s nodes) and DIPjs (Heberdens nodes). RA, Swelling, also ulnar deviation of MCPJ’s, boutonniere’s deformity of the thumb, swan neck of phalanges

Question 3

What are you looking to palpate in hand and wrist exam?

Answer 3

Carpals – easy to locate pisiform and then slightly diagonally distal to hook of hamate (Volar/palmer surface. Anatomical snuff box contains the scaphoid bone (Structures are extensor pollicis longus, brevis and abductor pollicis longus, also contains radial artery)
You can orientate yourself to all carpal bones from these more obvious ones to palpate.

Extensor tendons (dorsal) and flexor tendons (palmers) and Metacarpals
Metacarpal joints phalanges, Distal and Proximal Phalangeal joints
Radial Pulse

Question 4

What are the ROM of the wrist?

Answer 4

Flexion, Extension, ulnar deviation and radial deviation

Question 5

What are the normal ROM of wrist flexion?

Answer 5

70-80 degrees

Question 6

What are the normal ROM of wrist extension?

Answer 6

70-80 degrees

Question 7

What are the normal ROM for ulnar deviation of the wrist?

Answer 7

30-38 degrees

Question 8

What are the normal ROM for radial deviation of the wrist?

Answer 8

15-22 degrees

Question 9

What are the ROM of the thumb?

Answer 9

Ab/adduction/flexion/extension/opposition

Question 10

What is the ROM for the MCP’s?

Answer 10

Flexion/extension/Abduction/Adduction

Question 11

What is the range of motion for the DIPS/PIPS?

Answer 11

Flexion/Extension

Question 12

What is some hand joint play?

Answer 12

(long axis distraction/rotatory/valgus and varus of digits).
Intercarpal shear/proximal carpal row shear/distal carpal row shear
Metacarpal – Shear and Fanning

Question 13

What could compression of the median nerve result in?

Answer 13

Carpal tunnel syndrome

Question 14

What is the tinels test?

Answer 14

can be used all over the body to test for nerve impingement. Tested on hand inbetween thenar and hypothenar. Light tapping. A positive result means pain/tingling/numbness for the patient

Question 15

What is phalen’s test?

Answer 15

Putting hands in a reverse prayer position and holding for 1 minute. If pain or numbness occurs, this is a positive result for carpal tunnel syndrome

Question 16

What can cause instability to carpals?

Answer 16

Repetitive strain injury/injury/dislocation

Question 17

What does volar mean?

Answer 17

Palm side/sole side

Question 18

What is the most common ligamentous injury of the wrist?

Answer 18

Scapholunate disassociation

Question 19

Which bone fracture of the wrist could be a red flag and why?

Answer 19

Scaphoid as this can cause avascular necrosis