Hand/Wrist

Question 1

• 45-60, F (10:1)
• Sensory loss Distal cutaneous nerve
• Hand falls asleep/clumsy (loss of grip strength)
• Symptoms worse at night + activity related
• (-) Wrist flexion
• Management?

Answer 1

Carpal Tunnel Syndrome

Test
- Direct pressure (gold standard)
- Phalens

-PRICE, Brace > Mob > PFROM > Grip strength

Question 2

• Repetitive/prolonged wrist Ext
• Claw hand
• Can have dysfunction in only sensor or only motor or
  both.
• Management?

Answer 2

Guyon’s Canal Syndrome
aka “Handlebar Palsy”

• Educate (avoid MOI)
• Splint (night)
• Nerve gliding

Question 3

• Young mother of newborn
• Pain at wrist (rad) worse when picking up kid
• +/- swelling at wrist
• (-) Ulnar deviation, gripping
• Management

Answer 3

De Quervain’s Tenosynovitis

• EPB + AbdPL
• PRICE, avoid aggrev. > Brace with spica

Question 4

• 30 y.o, M
• Pain in the wrist (dorsal radial side)
• MOI: prolonged use of crutches
• Swelling, weak grip strength, crepitus
• +/- CTS symptoms
• Tests? Management?

Answer 4

Scapholunate dissociation

Test:
- Ballottement Test - Watson Test

Management:
- PRICE > Immobilize > RPFROM

Question 5

• 15-30, M
• Wrist pain post FOOSH
• (-) extension +/or radial deviation
• (+) immobilization
• Difficulty gripping and thumb movements
• Management?

Answer 5

Scaphoid fracture

Test:
Direct palpation of scaphoid causes pain

Management:
- Referral for surgical consult (AVN or non-union)
- Firm brace
- 4-6 weeks start PFROM > grip strengthening

Question 6

MOI: FOOSH in hyperextension and:

Radial deviation?
Ulnar deviation?

Answer 6

• Scaphoid fracture
• S-L Dissociation