Upper Eval Exam 3

Bone with styloid process and Lister’s Tubercle

Radius

Radial Collateral Stress Test

• Varus stress test for wrist instability

• Examiner stabilizes distal radius and ulna

• Other hand grasps around distal carpal row and metacarpals

• Apply a varus force

Radial Collateral Stress Test Positive

Pain and/or laxity on lateral aspect of wrist

Radial Collateral Stress Test Pathology

Radial Collateral Ligament

Ulnar Collateral Stress Test

• Valgus stress test for the wrist

• Examiner stabilizes distal radius and ulna with one hand

• Other hand grasps around distal carpal row and metacarpals

• Apply a valgus force

Ulnar Collateral Stress Test Positive

Pain and/or laxity on medial aspect of wrist

Ulnar Collateral Stress Test Pathology

Ulnar Collateral Ligament

Phalen’s Test

• Patient seated with elbows flexed and propped on table

• Let wrists droop into flexion and maintain position for up to 3 minutes

Phalen’s Test Positive

Reproduction of Median Nerve Symptoms

Phalen’s Test Pathology

Carpal Tunnel Syndrome

14 bones making up the fingers

Phalanges

Interossei and Lumbricals

Deep hand intrinsics

Formed by 2nd and 3rd metacarpals

Longitudinal Arch

Extensor Carpi Ulnaris, Extensor Carpi Radialis Brevis, Extensor Carpi Radialis Longus

Wrist Extensors

8 bones arranged in 2 rows

Carpal Bones

Restrains tendons and divides hand into compartments

Retinacular System

Watson Test

• Examiner grasps the distal forearm with thumb over palmar aspect of scaphoid

• Grasp metacarpals and take wrist into ulnar deviation and slight extension

• Apply force over scaphoid pushing in dorsal direction and maintain pressure

• Passively move wrist into radial deviation and slight flecion

• Release pressure over scaphoid

Watson Test Pathology

Scapholunate Stability

Watson Test Positive

Thunk or reproduction of dorsal wrist pain

Fracture of the distal radius and ulna with dorsal displacement

Colles Fracture

Wrist and Thumb flexors on radial side do what

Radial Deviation

Flexor Digitorum Superficialis are what

Finger Flexor Muscles

Bone with styloid process and ulnar head

Ulna

Infection in closed finger compartments

Felon

Compression Test

• Patient seated with elbow flexed and wrist neutral

• Hand should be relaxed so MCP joints are flexed

• Stabilize with one hand over distal forearm/wrist

• Examiner places thumb at MCP joint and applies axial load

Compression Test Positive

Pain over affected metacarpal or carpal

Compression Test Pathology

Fracture of Metacarpal or Carpal

Deformity caused by central tendon slip injury

Boutonniere Deformity

Origin point for wrist and finger flexors

Medial Epicondyle

Saddle joint allowing thumb flexibility

Thumb CMC Joint

Includes Scaphoid, Lunate, Triquetrum, Pisiform

Proximal Carpals

Scaphoid Compression Test

• Patient seated with elbow flexed and wrist in neutral

• Examiner stabilizes at wrist with one hand

• With other hand examiner grasps thumb and applies axial load through the first metacarpal

Scaphoid Compression Test Positive

Pain over Scaphoid or first metacarpal

Scaphoid Compression Test Pathology

Scaphoid/1st metacarpal fracture

TFCC Compression Test

• Patient seated with elbow flexed and wrist in neutral

• Examiner stabilizes at distal forearm

• Other hand grasps around metacarpals

• Passively take patients wrist into ulnar deviation and apply axial compression

TFCC Positive

Pain or click on ulnar side of wrist

TFCC Pathology

TFCC Tear

Abductor Digiti Minimi, Flexor Digiti Minimi Brevis, Opponens Digiti Minimi

Hypothenar Muscles

Most common dislocated carpal, displaced anteriorly

Lunate

Attach to PIP and DIP volar plates

Cruciate Fibers

Flexor Tendon Avulsion Test

• Patient seated with elbow flexed and forearm supinated

• Ask patient to make a fist

Flexor Tendon Avulsion Test Positive

Inability to make a fist

Flexor Tendon Avulsion Test Pathology

Integrity of the flexor digitorum profundus tendon

Radiocarpal Glide Test

• Patient seated with elbow flexed

• Examiner stabilizes distal radius and ulna with one hand

• Other hand grasps around distal carpal row and metacarpals

• Apply an anteroposterior force then a posteroanterior force

Radiocarpal Glide Test Positive

Pain, crepitus, or more mobility then the uninjured side

Radiocarpal Glide Test Pathology

Test stability of radiocarpal articulation

Joint displacement due to ligament damage

MCP and IP Dislocation

Fracture of the neck of the 5th metacarpal

Boxer Fracture

Neuropathic Disorder after an injury

Complex regional pain syndrome

Abductor Pollicis Longus, Extensor Pollicis Brevis

Tunnel 1 Muscles

Extensor Carpi Radialis Longus, Extensor Carpi Radialis Brevis

Tunnel 2 Muscles

Extensor Pollicis Longus

Tunnel 3 Muscles

Extensor Digitorum, Extensor Indicis

Tunnel 4 Muscles

Extensor Digiti Minimi

Tunnel 5 Muscles

Extensor Carpi Ulnaris

Tunnel 6 Muscles

Most common carpal fracture, slow to heal

Scaphoid Fracture

Injury from direct contact or axial load

Phalangeal Fracture

Characteristic deformity of Colles Fracture

Silverfork Deformity

Bleeding under nail due to injury

Subungual Hematoma

Origin Point for wrist and finger extensors

Lateral Epicondyle

Extensor Tendon Avulsion Test

• Patient seated with elbow flexed and forearm in pronation

• Examiner stabilizes the PIP of the affected finger

• Ask the patient to fully extend the finger

Extensor Tendon Avulsion Test Positive

Inability to extend at the DIP

Extensor Tendon Avulsion Test Pathology

Test the integrity of the extensor digitorum tendon

Composed of 29 bones including radius and ulna

Wrist Structure

Wrist flexors and extensors on ulnar side do what

Ulnar Deviation

5 Carpometacarpal joints in the hand

CMC Joints

Fibro-osseous between hook of hamate and pisiform

Tunnel of Guyon

Thumb Index Finger Pinch Test

Patient actively pinches thumb and index finger together

Thumb Index Finger Pinch Test Positive

Reproduction of pain over Scaphoid

Thumb Index Finger Pinch Test Pathology

Assess presence of Scaphoid Fracture

Superficial injuries that resolve quickly

Contusions

Tendon Insertion at Middle Phalanx

Central Slip

Lunotriquetral Ballottement Test

• Patient seated with elbow flexed and forearm pronated

• Grasp triquetrum with one thumb and index finger over the pisiform

• Other thumb placed over lunate and index finger over carpal tunnel

• Apply anteroposterior and then posteroanterior force to lune

Lunotriquetral Ballottement Test Positive

Pain, laxity, crepitus

Lunotriquetral Ballottement Test Pathology

Assess integrity of lunate and triquetrum articulation

Injury affecting extension at proximal interphalangeal joint

Extensor Tendon Rupture at PIP

Palmaris Longus is what

Wrist Flexor Muscle

Pulley for Extensor Pollicis Longus

Lister’s Tubercle

Extend from phalanx head into volar plate

Accessory Collateral Ligaments

Includes volar plate and collateral ligaments

MCP Joint Ligaments

Flexor Carpi Radialis does what

Wrist Flexor Muscle

Fingers and Thumb Ability to grasp

Prehension

Connective tissue and extensor digitorum tendons structure

Extensor Mechanism

Modified Carpal Compression Test

• Patient seated with elbow flexed and forearm supinated and supported on table

• Examiner grasps the wrist with thumbs overlapping the median nerve at proximal edge of carpal tunnel

• Apply direct pressure for 5 seconds

Modified Carpal Compression Test Positive

Paresthesia develops or increases in median nerve distribution

Modified Carpal Compression Test Pathology

Assess Carpal Tunnel Syndrome

Humeral Fracture of Elbow Dislocation

Mechanism of Injury for Radial Nerve Palsy

Avulsion of extension tendon from distal phalanx

Mallet Finger

Abductor Pollicis Brevis, Flexor Pollicis Brevis, Opponens Pollicis, Adductor Pollicis

Thenar Muscles

Most common injury from valgus or axial force

MCP and IP Sprains

Structure that allows extensor digitorum contraction

Dorsal Hood

Attach to MCP, PIP, DIP volar plates

Annular Rings

Interphalangeal joints for finger movement

IP Joints

Fracture from FOOSH with wrist flexion, anterior displacement

Smith’s Fracture

Controlled grip, like throwing a ball

Precision Grip

Thumb Flexor Muscle

Flexor Pollicis Longus

Inflammation of Extensor Pollicis Brevis and Abductor Pollicis Longus

De Quervain’s Tenosynovitis

Flexor Carpi Radialis, Flexor Carpi Ulnaris, Palmaris Longus

Wrist Flexors

Vibration Test

• Patient seated with elbow flexed and wrist in neutral

• Stabilize at wrist/hand

• Then tap at the distal end of segment to cause vibration

Vibration Test Positive

Pain