1. hand pain or stiffness 2. hard tissue enlargement of 2+/10 joints 3. less than 3 swollen MCPs (if yes, prob RA) 4. hard tissue enlargment of 2+ DIP joints 5. deformity of 2+ selected joints

LECTURE 14B: WRIST/HAND EVAL AND EXAM Flashcards by Rebecca Nam

wrist and hand eval: assessing above and below?

wrist: elbow and hand
hand: elbow, and wrist
probably need to assess spine and elbow (double crush)

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complexity, dexterity of wrist and hand allows for UE versatility

works most often in conjunction with elbow/forearm complex

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patient history: what should you for sure ask?

hand dominance
sport or job?

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common complaints for patient history: wrist and hand involvement

Unable to turn doorknob or key in ignition

Difficulty or pain w/ pushing and pulling activities
i.e opening & closing doors

Restricted ability to grasp objects most common complaint**

Restricted ability to use hand for personal grooming, etc

Difficulty or pain w/ pushing self up from chair

Unable to carry objects / frequently drop objects

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carpal tunnel: stress? diabetes? etc.
definitely want to check yellow flags via _ and _

PHQ-2
OSPRO-YF

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patient health questionaire PHQ-2
what are the 2 questions

Over the past 2 weeks, how often have you had little interest or pleasure in doing things?
Over the past 2 weeks, how often have you felt down, depressed or hopeless?

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systems review of wrist hand is same as elbow. What does it include

history and trauma is HUGE

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traumatic wrist injury: usually fracture what?

distal radius
Colles: extension fracture with dorsal displacement, SHORTENED FOREARM

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FOOSH with fractured distal radius. What is most common?

Colles’ fracture with dorsal displacement, results in shortened forearm

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MOST COMMONLY FRACTURED CARPAL BONE

scaphoid 70%
***thumb function!
FOOSH MOI

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pain in snuffbox
negative x ray fresh after injury
still pain 2 weeks after injury

scaphoid fracture
*commonly missed until they start to heal

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treatment for scaphoid fracture

cast 6-8 weeks, surgical pining

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healing time for scaphoid fracture

healing time: 8 weeks-4 months or more bc POOR BLOOD FLOW

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wrist pain on ulnar side with gripping
TTP over hamate
pain with resisted 4th/5th finger flexion

hook of hamate fracture

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MOI of hook of hamate fracture

stress fx from repetitive torque stresses in bat, racket, club type sports

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MOI of TFCC tears

axial loading
ulnar deviation motions/distraction of wrist

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volkmann’s ischemic contracture is a medical

medical emergency!!!!!!
MOI: MAJOR CRUSH TRAUMA causing within 1-2 hours
1. lack of BF to forearm
2. compartment syndrome
3. prolonged lack of BF causing shortened, contracted positions, injury to mm and nerves

flexion contractures in wrist, hand, fingers

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1st CMC OA
CPR

hand pain or stiffness
hard tissue enlargement of 2+/10 joints
less than 3 swollen MCPs (if yes, prob RA)
hard tissue enlargment of 2+ DIP joints
deformity of 2+ selected joints

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de Quervain’s Tenosynovitis is inflammation of synovial sheath around what 2 tendons

ABD POLLICUS LONGUS
EXTENSOR POLLICUS BREVIS

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MOI: de quervain’s

repetitive overuse problem
but direct trauma can cause this

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lunotriquetral ligament sprain MOI

forced wrist ext, radial deviation

radioscapholunate ligament sprain MOI

MOI: FOOSH

Smith Fracture is WHAT

AKA ’reverse Colles’ fx’ of distal radius
Flexion fx w/ volar displacement
Extra-articular

way less common

what are common causes of finger and hand injuries?
*note: no matter what, UE/HAND are among **most commonly injured **sites in body

sharps
tools
machinery
hot/cold
electricity
chemicals
biological
vibration
gravity

When you have OA, what are these? enlargement at dorsal DIP enlargement at dorsal PIP

DIP: heberden's nodes PIP: bouchard's nodes | NOT RA! MCP = RA, DIP/PIP = OA

flexion of MCP extension of PIP flexion of DIP

SWAN NECK tear volar plate everything around contracts - intrinsics | DUE TO RA or trauma

Ext of MCP and DIP w/ flex of PIP Rupture of central tendon of extensor hood due to RA or trauma

BOUTONNIERE DEFORMITY

Thickening of flexor tendon sheath causing tendon to ‘catch’ Eventually will not extend Common w/ RA

trigger finger

what is mallet finger and what is MOI?

* Avulsion of distal slip of extensor tendon * MOI: forced flex of DIP: JAMMED * ↓ DIP extension, normal PIP extension | NEED SURGERY

jersey finger is what?

grabbing injury avulsion of FDP tendon, MOI forced extension against active flexion typically 4th digit

ulnar drift is what? associated with what dx

ulnar deviation of digits from weakening passive structures, MOI: RA

ape hand is what?

thumb falls in line with fingers (ape), atrophy of thenar mm, unable to oppose or flex NERVE INVOLVEMENT: median nerve palsy

boxer's fracture: of _ and _ bone

4th and 5th MC bone MC snaps on distal end, lose a knuckle (loss MCP height) MOI: direct impact to MC shaft or head

What is dupuytren's contracture

palmar fascia contraction with inger deformity in MCP and PIP joints most often 4th and 5th digits *diabetes, comorbidities bc connective tissue not as good

treatment for boxer's fracture

casting, splinting

gamekeeper's thumb is what? MOI?

sprain/tear of thumb UCL *skier's thumb MOI: forced abduction with thumb hyperextension | from killing/snapping rabbit or chicken necks

most common ligament injured in hand

gamekeeper's thumb UCL OF THE THUMB

treatment of gamekeeper's thumb

spica splint/cast for 6-10 weeks

What are 3 MOIs of UE peripheral nerve injuries?

1. traction/stretch 2. compression 3. laceration | (stretch, squish, cut)

what conditions predispose a nerve to damage?

1. Diabetes 2. metabolic conditions 3. autoimmune diseases (RA, sjogrens, etc) 4. infection 5. ETOH abuse 6. meds/toxins

3 classifications of peripheral nerve injuries

1. **neurapraxia** --> transient block, nondegenerative sunderland type 1 2. **axonotmesis **--> lesion in continuity, degenerative 3. **neurotmesis** --> nerve damage, degenerative with poorer outcomes | neuropraxia: traffic jam with block

axonotmesis is...

nerve with block, now other side of nerve is starting to damage 2-4...NERVE DEGENERATION

neurotmesis is defined as...

complete severing, other side of nerve degenerates with poor outcomes (ripped off trunk or compressed so much with no blood flow) NERVE DAMAGE

cervical radiculopathy is defined as

damage to spinal nerve roots (C5-T1)

TOS is defined as....

Compression of neural and/or vascular structures that pass through thoracic outlet

review slides 38-42

What is the most commonly injured peripheral nerve?

radial nerve

lateral elbow pain no numbness or tingling (no sensory) weakness of: 1. supinator or 2. EI 3. EPL

radial tunnel syndrome

most common peripheral neuropathy in the UE

CTS! median nerve compression in carpal tunnel

CTS Diagnosis made with what 3 things? 80% accuracy

1. positive tinel's sign 2. positive phalens sign 3. sensory changes in median nerve

What are the 5 areas of compression of cubital tunnel syndrome?