wrist and hand examination - lecture

hand pain differential diagnosis possibilities

hand joint anatomy, systemic inflammatory condition, elbow refers down (neurogenic or somatic), shoulder refers down (neurogenic), cervical spine refers down (neurogenic), heart attack, psychogenic

hand anatomy differential diagnosis

fractures, OA, tendonopathy, ligament tear, nerve lesion, joint degeneration,

what are common diagnosis in a 75 year old male

OA, RA, fractures, C-spine referral

what are common diagnosis in a 45 year old male

carpal tunnel, fracture, rediculopathy

what are common diagnosis in a 15 year old male

fracture, dislocation, sprain

what is an additional thing to ask when doing a hand eval

hand dominance

FOOSH may lead to

colles fracture, smiths fracture, scaphoid fracture, and lunate fracture

what is the most common fracture

colles fracture

how does colles fracture occur

displacement of the distal radius in a dorsal direction from landing on palm

how does smiths fracture occur

displacement of the distal radius in a ventral direction from landing on the dorsum of the hand

do scaphoid fractures show up immediately on an x-ray

no! be sure to check for pain at the base of the anatomical snuff box

with digital hyperextension there is

dorsal dislocation

with digital valgus there is

lateral dislocation

with digital varus there is

medial dislocation

pollicis hyperextension leads to

dorsal dislocation / volar plate rupture

a boxers fracture is caused by

punching an object

what is a boxers fracture

the 4th or 5th metacarpal is proximally displaced

what is mallet finger caused by

a ball to the tip of the finger

what is mallet finger

a forceful hyperextension which results in a rupture of avulsion of the extensor tendon where it inserts into the distal phalanx of the finger and the distal phalanx rests in a flexed position

a rupture of the extensor tendon leads to

an inability to extend and resting position is in flexion

a rupture of the flexor tendon leads to

an inability to flex and resting position is in extension

carpal tunnel syndrome is due to

repetitive stress and compression of the median nerve in the carpal tunnel

De Quervain tenosynovitis is due to

repetitive stress and inflammation of the first extensor compartment

what increases risk for carpal tunnel syndrome

diabetes, pregnancy, and hypothyroidism

what are functional questionaires for the wrist and hand

DASH, michigan hand outcome, functional status scale, carpal tunnel function disability, RA evaluation record

digital clubbing

an expansion of the circumference of the fingers typically due to cardiovascular and pulmonary issues. Needs immediate referral.

ulnar drift of the fingers is typically due to

RA

osteoarthritis impacts

the IP's. Bouchard is the PIP and heberden is the DIP

sign of benediction is due to

ulnar nerve palsy

ape hand deformity is due to

medial nerve palsy

intrinsic minus or claw hand is due to

ulnar and median nerve palsy

drop wrist is due to

radial nerve palsy

Dupuytrens contracture is due to

fascia thickening of the flexor tendons which limits AROM and PROM

Boutonniere deformity is due to

extensor hood rupture. It is an inability to extend PIP but still extend DIP