Wrist and Hand Flashcards Preview

7232 Diagnosis Summaries > Wrist and Hand > Flashcards

Flashcards in Wrist and Hand Deck (24):

- chronic compression of median nerve as it passes through carpal tunnel
- inflammatory response
- compromised neural blood flow
- fibrotic changes in CT of nerve
- demyelination
- axonal degradation



chronic etiology
- repetitive wrist flexion and extension
- intense gripping
- poor ergonomic wrist flexion
- computer keyboard
- vibrating power tools
- conditions that alter fluid balance may predispose - i.e. pregnancy



acute etiology
- sudden trauma
- wrist fracture
- crush injury
- burns
- constrictive casts
- handcuffs
- tight gloves
- repetitive/forceful gripping



- pain, numbness, and/or tingling in distribution of median nerve distal to wrist
- pain at night
- activities requiring prolonged flexion or extension of the hand will increase symptoms



- degeneration and thickening of the tendon sheaths of APL and EPB and extensor retinaculum
- causes entrapment of tendons in dorsum (stenosing tenosynovitis)

De Quervain's tenosynovitis


- gradual and insidious onset usu due to overuse, repetitive movements of the thumb, arthritis, and activities that stress the dorsum of the forearm (painting, hammering, golfing, typing, etc.)

De Quervain's tenosynovitis


- radiating pain along first extensor compartment - metacarpal or prox phalanx to distal ⅓ of forearm
- swelling at base of thumb
- "sticking" or "stop-n-go" sensation with the thumb when trying to move
- agg: thumb motions, grasping with thub, ulnar deviation, wrist extension

De Quervain's tenosynovitis


- localized swelling
- TTP around radial styloid process
- pain with active or passive stretching of APL and EPB tendons (ulnar deviation with thumb fixed)
- crepitus of tendons moving through sheath
- active radial deviation pain limited

De Quervain's tenosynovitis


- common in older people, esp. post-menopausal women
- young: usu due to MVA, fall from heights, sports
- most common physeal fx in children

distal radius fracture


- stiffness and pain secondary to resumption of activity after cast/splint removal
- pt may be reluctant to move the digits due to the tendons having to glide past injury location

distal radius fracture


- even after fx healed, wrist deformity often persists with the hand dorsally displaced (Colle's)
- ulna may be prominent
- wrist swollen and tender
- palpation may elicit crepitus

distal radius fracture


- repetitive strain to UCL until fracture

gamekeeper's thumb


forced abduction of the thumb hand

Skier's thumb


- ℅ pain, swelling, ecchymosis at ulnar aspect of MCP of thumb

gamekeeper's (skier's) thumb


- with complete tear, thumb rests with radial deviation and supination
- ℅ pain with AROM and PROM of thumb
- small lump may be palpable at ulnar aspect of thumb MCP

gamekeeper's (skier's) thumb


- forceful loading at distal phalanx into extension while FDP is active (during grasp)
- causes rupture or avulsion of FDP at insertion on distal phalanx
- most commonly involves ring finger
- can occur with or without avulsion fx

Jersey Finger (FDP avulsion)


sudden pain at distal phalanx with activity, such as grabbing a player's jersey

Jersey Finger (FDP avulsion)


- pain at distal phalanx of finger
- pt lacks active flexion at DIP (isolate by blocking PIP and MCP motions)
- edema - may assume extended position relative to other joints
- palpate for retracting tendon (could be fx)

Jersey Finger (FDP avulsion)


- avulsion of the extensor tendon from distal insertion
- ball or some object hits phalanx, forcing flexion while extensor mechanism is active
- can occur with or without fx

mallet finger


history of jamming injury (ball catching sports)

mallet finger


- pain at dorsal DIP
- unable to actively extend distal phalanx, rests in flexed position

mallet finger


- usu occurs with hyperextension and radial deviation of the wrist (FOOSH with wrist extended)
- little swelling and ecchymosis is present except in snuffbox
- may have increased pain with axial compression on thumb metacarpal

scaphoid fx


macrotraumatic injury to an extended hand or hx of degenerative diseases



- ulnar sided wrist pain
- painful catching and clicking of the wrist in forearm rotation, ulnar deviation, gripping objects, activities with loading and unloading (ex. bench press)
- dorsal/palmar side of TFCC is often ttp