Wrist/hand Examination

Front 1

Distal Radioulnar Joint loose/close pack

Back 1

Loose: 10 deg of sup
Close: 5 deg of sup

Front 2

Wrist Motions: Flexion/Extension axis through head of the capitate

Back 2

Flexion: 60% midcarpal, 40% radiocarpal
Extension: 66.5% radiocarpal, 33.5% midcarpal

Front 3

1st CMC Joint Capsular Pattern

Back 3

Abduction most limited followed by extension

Front 4

Colles' Fracture

Back 4

Most common radial fracture. Typically occurs in elderly adults. Occurs within 1" of the carpal articula rsurface. The distal fragment is angulated dorsally and may be dorsally and radially displaced

Front 5

Colles' Fracture Signs and Symptoms

Back 5

1. immediate (acute) pain
2. tenderness, bruising, and swelling
3. May have abnormal wrist posture
4. ROM is guarded due to pain

Front 6

Scaphoid fracture

Back 6

1. most common fracture of carpal bones
2. pain in anatomical snuff box with overpressure into ulnar deviation while the forearm is pronated
3. tenderness in anatomical snuff box

Front 7

Scapholunate Instability

Back 7

1. most common form of instability of carpal bones
2. involves a tear of the scapholunate interosseous ligament: scaphoid shift test

Front 8

Distal Radio-unlar instability

Back 8

Since the TFCC is the primary stabilizer of this joint, injury to the TFCC may result in joint instability

Front 9

Carpal Tunnel Syndrome Description

Back 9

Any process which decreass the volume of the tunnel or increaes the volume of its contents will crowd the median nerve interfering with the blood supply and cause it to malfunction
Early malfunction: dysesthesia
Late malfunction: thenar muscle atrophy and weakness

Front 10

CTS Etiology

Back 10

1. Deformity of a Colles' or carpal fracture
2. Arthritic spurs
3. Thickening of flexor retinaculum
4. Fluid retention
5. Carpal synovitis
6. Tenosynovitis

Front 11

CTS Signs & Symptoms

Back 11

1. Paresthesia and dysesthesia in the median nerve distribution of the fingers
2. Many complain of pain in wrist and symptoms at night
3. increased symptoms during sleeping hours and during sustained manual activity, like driving or knitting
4. atrophy of thenar muscles
5. Sensory loss: Palmar and dorsal thumb, index, iddle and lateral half of ring finger
6. Weakness: FPB, APB, OP, lateral two lumbricals
7. Positive carpal compression, wrist flexion (Phalen's) and percussion (Tinel's) tests

Front 12

Dupuytren's Contracture

Back 12

Palmar fascia may undergo a nodular, hypertrophic degeneration. Contraction of the fascia pulls the finger into a fixed flexion deformity at the MP joint and/or PIP joint. Usually occurs in the 4th or 5th digits. Etiology unknown.

Front 13

Trigger Finger

Back 13

Fibrous sheath over the flexor tendon at each MP joint thickens, which narrows the space beneath the sheath while the underyling segments of the tendon enlarge as a nodule. Passage of the nodule under the thickened fibrous sheath produces a sensation of snapping

Front 14

Trigger Finger Signs & Symptoms

Back 14

1. Complain of snapping when actively flexing or extending the affected finger
2. Nodule may be palpable jsut proximal to the affected MP joint
3. Snapping during active flexion palpable over the palmar aspect of MP Joint

Front 15

Dequervain's Tenosynovitis

Back 15

Tendons of APL and EPB share a common tendon sheath as they cross the radial styloid. The sheath can become inflammed from repetitive activity. Digital branches of the radial nerve which course over the tendons may become irritate as well.

Front 16

Dequervain's Signs and Symptoms

Back 16

1. Pain in the radial aspect of the wrist and thumb which may be intesified by wrist or thumb movement
2. May complian of pain and paresthesias in the dorsum of the thumb, index and middle fingers
3. Swelling may be palpable or visible over the tendons
4. Positive Finkelstein's Test
5. Pain with isometric resisted thumb extension or abduction

Front 17

Tendon Lacerations in the Hand or Wrist

Back 17

Requires surgery. Due to intricate gliding of tendons in hand needed for normal function, scarring can have a dramatic effect on function by restricting gliding. Timely mobilizing of the tendons using dynamic spinting is crucial for best outcome

Front 18

Ganglion

Back 18

Cystic masses (synovial herniation) that emerge from tendon sheaths or joint capsules
)

Front 19

Additional entrapment neuropathies

Back 19

ulnar nerve at elbow and wrist
radial nerve at elbow