Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Advanced Physical Dx > Hand and Wrist > Flashcards

Hand and Wrist Flashcards

(59 cards)

Start Studying
1
Q

Hand/Wrist Historical Components

(12)

A
  1. Age
  2. Handedness (R or L) - include this in any upper extrem focused hx HPI
  3. CC
  4. Occupation
  5. Previous injury
  6. Previous surgery
  7. Sx related to specific activities
  8. Pn exacerbation activites
  9. Pn improving activities
  10. Location
  11. Frequency
  12. Duration
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Principle MOI

(4)

A
  1. Throwing
  2. Weight bearing
  3. Twisting
  4. Impact
    • ​high energy
    • low energy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Common UE Symptoms

(4)

A
  1. Pn in wrist/hand
  2. Numbness/parasthesia in wrist/fingers
  3. Loss of movement and stiffness
  4. Deformities
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Physical Exam Template

(5)

A
  1. Inspection
  2. Palpation
  3. ROM
  4. Neuro Exam
  5. Special Tests
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Initial Inspection Elements, Wrist/Hand

(4)

A
  1. Observe entire upper extrem
  2. Examine hand in function
  3. Deformities
  4. Attitude of hand
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Attitude of Hand

(Define)

A

Position the extremity is in at rest

  • Cradled?
  • Supported?
  • Swinging c gait?
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Dorsal Hand/Wrist Inspection

(4 aspects, 1 c 3 specifics)

A
  1. Hills/Valleys
  2. Metacarpal head height
  3. Finger nails
    • ​Pale/white = anemia or circulatory problem
    • Spoon shaped = fungal infection
    • Clubbed = resp or congenital heart
  4. Deformities
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Palmar Hand/Wrist Inspection

(4 aspects)

A
  1. Creases
  2. Thenar/hypothenar eminence
  3. Hills/valleys
  4. Web spaces
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Cascade Sign

(def, documentation)

A

Def: Normal hand positioning when all fingers point to scaphoid area when flexed @ PIP

Documentation: “No rotational abnormalities”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Motor Function, Hand

(2 evaluations)

A
  1. Grasp/grip strength
  2. Pinch strength
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Sensory Evals of Hand

(4)

A
  1. Stereognosis
  2. Pinprick
  3. Light touch
  4. Two-point descrimination
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Rapid Assessment, Hand Fctn

(3 tasks)

A
  1. Structural space and stability
  2. Open and close
    • ​Flex digits
    • Extend digits
    • Adduct, Abduct
  3. Pinch, opposition, sensation of digits
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Tendonous ROM Evaluation

(2 tendons, MOA, differential)

A

Tendons:

  1. Flexor digitorum superficialis (FDS)
  2. Flexor digitorum profundus (FDP)

MOA:

  1. Isolate - Extend all digits except the one being tested
  2. Prompt flexion at each joint

Differential: contracture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Wrist ROM Evaluation

(Expectations, MOA)

A

Expectation:

elbow and wrist equally participate in pronation and supination

  1. Pronation
  2. Supination
  3. Flexion (palmar/volar)
  4. Extension (dorsiflexion)
  5. Radial deviation
  6. Ulnar Deviation

MOA:

  • Option 1: instruct to pronate, supinate, flex, and extend in space
  • Option 2: instruct pt to pronate and supinate from “handshake position” c forearm rested on table . have pt hang wrist over edge of table for flexion/extension. pt may perform radial/ulnar deviation c palm and forewarm on table. you may assist the pt beyond a limited ROM if he/she can handle it.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Finger ROM Evaluation

A
  1. Flexion - should touch pad to palm
  2. Extension
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Forearm Nerve Patterns

A

Know this picture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Wrist/Hand Dermatomes

A
  • C6 - make a 6 c thumb and index
  • C7 - make a 7 c wrist and middle finger
  • C8 - what’s next to C7
  • T1 - create a T c contralateral hand
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Hand Myotome

(6 nerves)

A
  • Wrist ext - C6
  • Wrist flxn - C7
  • Finger ext - C7
  • Finger flx - C8
  • Finger abd - T1
  • Finger add - T1
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Wrist Boney Anatomy

A

Carpal bones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Boney Landmarks, Wrist

A
  1. Radial styloid
  2. Scaphoid
  3. 1st MC/trapezium joint
  4. Lunate
  5. Lister’s tubercle
  6. Ulnar styloid
  7. Triquetrium
  8. TFCC
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Radial Styloid and Scaphoid Palpation Technique

A

See picture

Navicular = Scaphoid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

1st MC/Trapezium Joint Palpation Technique

A

Note - for evaluating skier’s thumb

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Thumb CMC Joint Arthritis Eval

(2 aspects)

A
  1. Pain c gripping
    • Grind test (axial pressure to thumb while palpating CMC joint)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Lunate Bone Palpation Technique

25
Kienbock's Disease | (def, MOI, s/sx)
_Def_: Idiopathic osteonecrosis of lunate _MOI_: 1. Stress/compression fx of lunate 2. Disruption of blood supply 3. Secondary fragmentation _S/Sx_: Pn/stiffnest of wrist **s trauma**
26
Scapholunate Dissociation | (s/sx, dx tests)
_S/Sx_: * Pn, esp c **pressure over scaphoid tuberosity** or **dorsiflexion** * Swelling * Decreased ROM _Dx Tests_: X-ray shows widened scapholunate joint \>/= 3mm
27
Triangular Fibrocartilage Complex (TFCC) (anatomy, MOI's, injury eval)
_Anatomy_: thickened pad of CT, major ligamentous stabalizer of distal radioulnar joint and ulnar-carpus joint _MOI_: compression b/w lunate and head of ulna * Breaking fall c hand * Rotational forces (racket, throwing sports) _Injury Eval_: * Ulnar-sided wrist pn/swelling/loss of grip strength * "Click" c ulnar deviation * **Point tenderness distal to ulnar styloid** * TFCC load test * *axial load applied across pt ulnarly deviated wrist, reproduce pn* * *hand supination/pronation c forearm fixed, reproduce pn*
28
UE Myotomes | (2 categores, 2/3)
**Wrist:** * C6 - extension * C7 - flexion **Fingers:** * C7 - extension * C8 - flexion * T1 - abduction and adduction
29
Ulnar Nerve Testing
See image
30
Median Nerve Testing
See image
31
Radial Nerve Testing
See Image
32
Sensation Testing, Hand and Wrist
_Image Key_: * Red = radial nerve * Yellow = median nerve * Blue = dorsal cutaneous branch of ulnar nerve * Gray = Median antebrachial cutaneous nerve * Green = musculocutaneous nerve (lateral antebrachial cutaneous n)
33
Vascular Anatomy, Hand | (list 3 vessels, locations)
1. Radial artery 2. Ulnar artery 3. Collateral blood supply in hand
34
Allen's Test | (indications, procedure, results)
_Indications_: 1. Evaluate collatral blood supply to hand: ulnar-artery patency 2. Evaluation before * ​​ABG * Radial artery cannulation * CABG harvesting _Procedure_: 1. Pt elevate fist x 20 sec 2. Occlude radial and ulnar arteries c firm pressure 3. Pt open hand - should appear blanched/pale 4. Examiner release ulnar pressure - color should return w/i 5 sec 5. Repeat c radial artery _Results_: * Negative - hand color returns \< 5 sec * Positive - hand color returns \> 5 sec, remains pale until radial artery compression released
35
Degenerative Joint Dz, Hand Finding | (2)
1. _Heberden's Nodes_: bony enlargements @ DIP 2. _Bouchard's Nodes_: bony enlargements @ PIP *Both classic signs of osteoarthritis*
36
Mallet Finger | (MOI - 4 steps, dx test, tx)
_MOI_: 1. Forced flexion injury 2. DIP extensor tendon avulsion 3. DIP pn/swelling 4. Loss of DIP extension _Dx Test_: X-ray, checking for avulsion fx _Tx_: Splint, Stack or Linx *May hurt to extend DIP into splint when swollen, but not afterwards*
37
Long Finger Flexor Tests | (2)
1. Flexor Digitorum Superficialis Test * ​Flex finger at PIP * Only functioning tendon at PIP 2. Flexor Digitorum Profundus Test * ​Flex @ DIP *Inability to flex indicates tendon cut or denervation *
38
Jersey Finger | (MOI, s/sx)
_MOI_: Injury to flexor tendon d/t avulsion from rapid passive extenion of clenched fist _S/Sx_: * Loss of flexion @ PIP and/or DIP * + Sublimus test * + Profundus test
39
Boutonniere Deformity | (description, 2 causes, 2 tx)
_Description_: flexion deformity of PIP joint _Causes_: Interuption of central slip of extensior tendon 1. **Inflammatory condition (usually RA)** 2. Injury _Treatment_: * Conservative - splint * Surgical - ideally before 3 weeks
40
Swan Neck Deformity | (description, 2 causes)
_Description_: * PIP hyperextension * DIP flexion _Causes_: * Untreated mallet finger * RA _Treatment_: * Conservative - splint * Surgical - ideally treat before 3 weeks *Do not confuse c Boutonniere deformity!*
41
Ganglion | (description, pt pop, 3 tx)
_Description_: * Dull ache * Gelatinous-like fluid cyst arises from synovial sheath in joint * Located on volar or dorsal aspect of wrist/hand _Pt Pop_: women \> men _Treatment_: * Conservative * NSAIDs * Aspiration if bothersome * Surgical - not recommended, as pedicle of cyst is intra-articular
42
Carpal Tunnel Syndrome (pathophys, 6 causes, 5 exam components, 2 dx studies, 5 tx)
_Pathophys_: Median nerve entrapment and inflammation under transverse carpal ligament _Causes_: Female \> Male (inc incidence during pregnancy, self resolves after birth) 1. Repetitive job (typist, machinist) 2. Arthritis 3. Trauma (distal radius fx) 4. Thyroid dz 5. DM, inc risk 6. Idiopathic - **most common** _S/Sx_: * Hx * Pn (nocturnal) * Clumsiness * Observation * Thenar eminence wasting * ROM/Strength * Weakness (pictured) * +/- Decreased flexion * Neuro * Numbness/paresthesia (+/- positional dependence) * Abnml 2-point discrimination (\> 5mm) indicates neuropathy * Special tests * Tinel's Sign * Phalen's Sign _Dx Studies_: 1. NCS 2. EMG conduction _Treatment_: * Non operative * Splint (cock up), day and/or night * Steroid injection * NSAIDs * Surgical release * Artheroscopic * Open
43
Tinel's Sign (sensitivity, specificity, tenique, interpretation)
_Efficacy_: * Sensitivity = 44-70% * Specificity = 94% _Technique_: 1. Percuss **median nerve** @ carpal tunnel in wrist 2. Tap over volar carpal ligament _Interpretation_: * + test = reproducable pn/tinging along median nerve course * Suggests carpal tunnel dz
44
Phalen Test (sensitivity, specificity, technique, interpretation)
_Efficacy_: * Sensitivity = 70-80% * Specificity = 80% _Technique_: 1. Keep wrist flexed against resistance - 30 seconds to minute 2. Inverse praying position, place dorsum of each hand against each other _Interpretation_: positive test indicates median neuropathy (likely carpal tunnel syndrome) * Wrist flxn reproduces carpal tunnel syndrome * More specific if paresthesias or dysesthesia occur @ 30 sec
45
Electrodiagnostic Studies, Carpal Tunnel Syndrome (2)
1. Nerve conduction studies (NCS) 2. Electroyelogram (EMG)
46
DeQuervain's Tenosynovitis (def, 2 causes, 1 sxs, 1 special test, 3 tx)
_Def_: inflammation of * extensor pollicus brevis * abductor pollicus longus _Causes_: * Overuse * Acute injury/inflammation _Sxs_: tenderness over 1st dorsal compartment _Special test_: Finkelstein's test _Treatment_: * Conservative - rest, splint * Analgesia - NSAID or steroid injection * Operative tenosynovectomy
47
Finkelstein's Test | (2 Protocols, Interpretation)
_Protocols_: 1. ​Examiner brace wrist c ulnar deviation, passively flex thumb across palm 2. Asl pt to put thumb in fist then ulnar deviate _Interpretation_: Dorsal thumb pn suggestss **De Quervain's Tenosynovitis**
48
Scaphoid Fracture | (incidence, strucural quality, s/sx)
_Incidence_: Most commonly fractured carpal bone * 70-80% carpal bone injuries * 8% of all sports related fractures * 1 in 100 college football players _Structural Quality_: most susceptible to injury because * Bridge b/w proximal and distal rows of carpal bones * Load to dorsiflexed wrist as in FOOSH _T/Sx_: * Painful, swollen wrist post fall * Snuffbox tenderness * High frequency of nonunion and avascular necrosis * Initial x-rays often unremarkable
49
Trigger Finger (Pathophys, 4 causes, Typical Presentation, 3 S/Sx, 3 Tx)
_Pathophys_: Tendon narrowing/inflammation _Causes_: 1. Repetitive gripping 2. DM 3. DJD 4. Idiopathic _Presentation_: * Women \> Men * Dominant hand * Normal fingers - 1st, 3rd, and 4th digits _S/Sx_: * Finger stiffness * Popping/clicking * Finger locked in flexed position _Treatment_: * Non-operative (95% improve) * Steroid injection * NSAIDs * Operative - A1 pulley release
50
Duputren's Contracture (def, 4 causes, 2 s/sx, 2 tx indications, 3 tx)
_Def_: Knots of tissue that forms thick cords on palmar surface of hand _Causes_: (inc frequency in men of northern european descent) 1. FH 2. Tobacco 3. EtOH 4. DM _S/Sx_: * Lump of tissue c thickening skin * Flexion contracture of 4th and 5th digits _Surgery_: * Indications * Rapidly progressive contracture * Inconvenience * Operations * Fasciotomy * Fasciectomy * Amputation
51
Boxer's Fx (description, major cause, presentation)
_Description_: 5th metacarpal fx _Major cause_: trauma _Presentation_: * Knuckle depression (even after tx) * +/- Misalignment * Rotation * Laceration
52
Phalynx Fx | (Locations, S/Sx, Tx)
_Locations_: Proximal, middle, or distal phalynx on any finger _S/Sx_: * Pain/swelling * Angulation * Rotation _Tx_: splint and refer to ortho
53
Skier/Gamekeeper's Thumb | (description, presentation, evaluation)
_Description_: Ulnar collateral ligament rupture of thumb and MCP joint _Presentation_: Unstable, c weak/ineffective pinch _Evaluation_: Radially-directed stress @ MCP joint = stable if \< 35 degree opening
54
Guidelines, Hand/Wrist Radiograph
_Typical views_: * PA * Lateral _Other views to consider_: * oblique * scaphoid * AP (in the event of severe trauma)
55
Referred Pn Causes, UE | (4)
1. Herniated cervical discs 2. Osteoarthritis 3. Brachial plexus outlet syndrome 4. Elbow/should entrapment
56
Dorsal Pn, Common Pathologies | (3)
1. **Gangion** - most common 2. Extensor tenosinovitis - overuse 3. Kienbach's Dz - lunate avascular necrosis
57
Volar Pn, Common Pathologies | (4)
1. Ganglion 2. Flexor tendinitis 3. Carpal tunnel syndrome 4. Thumb CMC joint arthritis
58
Common Pathologies, Radial Pn | (3)
1. Thumb CMC DJD 2. DeQuervain's tendonitis 3. Scaphoid Fx
59
Common Pathologies, Ulnar Pn | (3)
1. Extensor carpi ulnaris tendonitis 2. Synovitis 3. Triangular fibrocartilage complex tear

Advanced Physical Dx (2 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions