history
how did this injury occur? (mechanism)
when did you hurt your hand/wrist?
Where does it hurt?
Did u hear any sounds or feel a pop?
have you injured this hand/wrist before?
observation
attitude of the hand
bilateral comparison of wrist/hand (swelling, deformity, discoloration)
palmar surface(DIP, PIP, dist. and prox. palmar, and thenar creases; hypothenar eminence and thenar eminence)
dorsal surface (knuckles, fingernails)
attitude of the hand
the way the hand naturally rests and bilaterally compare, naturally slightly flexed MCP and IP joints, almost parallel fingers
proximal palmar crease
distal palmar crease
thenar crease
thenar eminence
hypothenar eminence
DIP creases
PIP creases
IP crease
Palpation(palpate the following noting point tenderness, deformity, etc.)
Soft tissue
tunnels 1-6
----
Bony
Radius styloid process
ulna styloid process
scaphoid
trapezium
metacarpals
phalanges
--
Carpal tunnel
Tunnel of guyon
thenar eminence
hypothenar eminence
palmar aponeurosis
flexor digitorum superficialis test
goes only to middle phalanges
active
hold other fingers in extension, especially DIP, deactivate profundus
bend the finger
negative if still can flex, but distal can’t bend which is normal
positive if can’t flex
looking for flexion of PIP
flexor digitorum profundus test
goes to distal joint
active
hold PIP joint of the specific finger
negative if DIP can flex
positive if can’t curl the finger, might feel a tug though
bunnel-littler test (intrinsic m. vs. capsule)
passive
note: capsule around joints doesn’t change, so it’s muscle tightness if stiff in one position, but if both positions are stiff, it’s the capsule that’s tight. changing proximal joint changes the muscle length.
PIP joint
hyperextend MCP
feel for pip mobility
release and test again(w/o MCP hyperextended)
feel for stiffness
-
same amount of stiffness(resistance) in both-the tighest structure is the capsule
difference of stiffness in the 2 phases-the intrinsic muscle is the tightest structure
retinacular test
passive
test for DIP joint
hold proximal joint and feel for mobility
then release the proximal joint and feel for difference in stiffness
-
same amount of stiffness(resistance) in both-the tighest structure is the capsule
difference of stiffness in the 2 phases-the retinaculum is the tightest structure
allen test(circulation)
for the wrist
pumping motion like 5 times, then squeeze tight around the wrist, release one artery but letting go of a finger, then redo with releasing the other one(reference from anatomical position, duh: medial side is the ulnar artery, lateral is the radial)
Even if one is blocked the other should help w/circulation, helps figure out which artery isn’t supplying blood
positive sign-not seeing refill
finklestein test
test for dequervain’s
dequervain’s disease-tenosynovitis around anatomical snuffbox area
test for inflammation of the sleeve around tendons
tenosynovitis-inflammation of sleeve around tendons
tuck thumb in(flex) and flex fingers and slowly ulnar deviate
should feel similar on both hands(pain)
positive-not the same feeling on both hands
tinel sign
tap over median nerve(passes through carpal tunnel) neurological symptoms to the fingers (median nerve supplies)
phalen’s test
tell them to put backs of hands together and press together for 30 seconds, compressing it, after 30 seconds, positive sign is neuro symptoms of median nerve
tenosynovitis
inflammation of sleeve around tendons
dequervain’s disease
tenosynovitis around anatomical snuffbox area
tests for carpal tunnel syndrome(name 2)
tinel sign test
phalen’s test
palpate the radius styloid process
lateral when the hand is in anatomical position, can palpate the distal tip and there’s a small but distinct groove on lateral edge
palpate the ulna styloid process
bumpy process on the medial side, visible too, easier palpation by radially deviating and having the extensor carpi ulnaris tendon contract
palpate the scaphoid(carpal navicular)
in anatomical snuffbox, distal to the radial styloid process, ulnar deviate to make it palpable
palpate the trapezium
distal to the snuffbox to palpate near its articulation with the 1st metacarpal; (to feel the trapezium and MT articulation, flex and extend thumb)
palpate metacarpals
palpate with thumb, index, and middle fingers, the dorsal and radial sides are easy to palpate
palpate the phalanges
palpate for differences(14 per hand), feel and check for swelling, tenderness, symmetry…
palpate the tunnel of guyon
at the hook of hamate on palmar side of hand, crossing of a line between the 4-5 digits and 1-2 digits
palpate the carpal tunnel
deep to palmaris longus(palmaris longus can be seen by opposing thumb to pinkie, some people don’t have it), proximal side is pisiform, navicular and the distal side is hamate hook and trapezium, home for median nerve and finger flexors to pass through
palpate the thenar eminence
base of thumb, dominant hand may have a more pronounced eminence, median nerve supplies to muscles of the thenar eminence
palpate the hypothenar eminence
proximal to pinkie to pisiform, ulnar nerve supplies the muscles by/in the hypothenar eminence
palpate the palmar aponeurosis
the palmar fascia extends to base of fingers, probe to check for thickened areas on the palmar side of the hand
tunnels 1-6 and the tendons
tunnel 1-abductor pollicis longus, extensor pollicis brevis
tunnel 2-extensor carpi radialis longus, extensor carpi radialis brevis
tunnel 3-extensor pollicis longus
tunnel 4-extensor digitorum, extensor communis, extensor indicis
tunnel 5-extensor digiti minimi
tunnel 6-extensor carpi ulnaris