PT 742 Wrist and Hand Diagnoses

What is De Quervain's Tenosynovitis?

Inflammation of synovial lining at 1st dorsal tendon compartment (APL, EPB)

What's a special test for De Quervain's Tenosynovitis?

Finkelstein's test

Where is pain typically with De Quervain's Tenosynovitis?

Snuff box, radial styloid

What movements causes pain with De Quervain's Tenosynovitis?

Abduction and extension of thumb

What is done with Finkelstein's test?

1. Make fist with thumb tucked it

2. Perform ulnar deviation

What are common interventions for De Quervain's Tenosynovitis?

1. Wrist andthumb

immobilization orthosis

2. Anti-inflammatory

modalities

3. Activity modification

4. Biomechanical re-education forthumb

Where is pain with Intersection Syndrome?

About 4cm proximal to De Quervain's Tenosynovitis (snuff box)

What is Intersection Syndrome?

Tendon inflammation/irritation/entrapment at the intersection where the 1st dorsal compartment tendons cross over with 2nd

What is Stenosing Tenosynovitis (trigger finger)?

Inflammation/entrapment of a flexor tendon as it passes through narrow A1 pulley, leading to a palpable tendon nodule

A tendon nodule with Stenosing Tenosynovitis (trigger finger) causes...

snapping upon extending the PIP from flexed position

In advanced cases of Stenosing Tenosynovitis (trigger finger), the tendon nodule can cause...

the PIP to be locked in flexion

What are interventions for Stenosing Tenosynovitis (trigger finger)?

1. Splint

2. Cortisone Injection

3. Activity Modification

4. Passive ROM

5. Iontophoresis

6. Pulsed US

7. Surgery

What is Dupuytren's Contracture?

Progressive conditions causing palmar fascia to shorten/thicken and pull the fingers into flexed position

Which fingers most commonly have Dupuytren's Contracture?

Digits 4 and 5

What are common interventions for Dupuytren's Contracture?

1. Steroid injection

2. Xiaflex injection and manipulation

3. Needle aponeurotomy

4. Surgery

What are common post-op rehab protocols for Dupuytren's Contracture?

1. "Pan splint"- Digits in extension

2. Tendon gliding

3. Wound care progressing to scar care

4. Edema control

5. Strengthening

What happens during Intrinsic Tightness test (Bunnel-Littler Test)?

1. MP held in extension

2. PIP is passively flexed

then...

3. MP held in flexion

4. PIP is passives flexed

What is a positive sign of Intrinsic Tightness test?

If PIP flexion is greater with MP flexed

What is jersey finger?

Avulsion fracture of distal phalanx by FDP

What digit is typically injured with jersey finger?

Ring finger

What is Skier's (Gamekeeper's) Thumb?

Injury of thumb MCP UCL

What is common MOI of Skier's (Gamekeeper's) Thumb?

Sudden forced radial deviation/thumb abduction

What can also occur with Skier's (Gamekeeper's) Thumb?

Avulsion fracture at ulnar base of proximal phalanx

What is a special test for Skier's (Gamekeeper's) Thumb - MCP UCL injury?

Valgus stress test in MP extension

What ligament is tested with valgus stress test in MP flexion?

Accessory collateral ligament

What is Sterner Lesion?

Torn UCL causing slippage of it superficial to adductor aponeurosis

What does Sterner Lesion cause?

Interposition of the adductor pollicis b/w the UCL and MCP joint

What is typically done for Stener's lesion?

Surgery

What is the most commonly sprained ligament of wrist>

Scapholunate ligament

What can tearing of scapholunate ligament cause?

1. Scaphoid instability

2. Impaired joint mechanics

3. Arthritis

What movement typically injures scapholunate ligament?

FOOSH

What are special tests for scapholunate ligament?

1. Scaphoid Ballottement Test

2. Watson's Scaphoid Shift test

What happens during Scaphoid Ballottement Test?

Glide scaphoid in AP plane while stabilizing lunate

What is a positive Scaphoid Ballottement Test?

Pain and increased movement compared to opposite side

What happens during Watson's Scaphoid Shift Test?

1. Provide firm pressure on palmar tuberosity of scaphoid

2. Start in ulnar deviation and extension

3. Move wrist into radial deviation and flexion

4. Release

What is a positive Watson's Scaphoid Shift Test?

Once pressure is removed, scaphoid snaps back into place

The Watson's Scaphoid Shift Tes is typically used to rule ________ scapholunate ligament injury?

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