CC hand
confirmation of DeQuervians
(+) on 5/7 of the following 1) (+) Finkelstein's test 2) TTP over APL and EPB tendons 3) pain over radial styloid process 4) edema 5) thickening 6) pain with resisted thumb extension 7) pain in 1st dorsal compartment with wrist movement
Intersection syndrome
1. Pain with palpation at intersection 2. Pain with passive wrist flexion and UD and active wrist extension c RD 3. (+) finklesteins MUST RULE out DEQUERVAINS and Radial Nerve adverse neural tension Must ALWAYS do a radial nerve tension test to rule out a nerve. Remember, use sensitization maneuvers like SB the neck to differentiate. Inflammation due to friction at the intersection of the 1st and 2nd Dorsal Compartments 1st Dorsal Compartment: APL and EPB 2nd Dorsal Compartment: ECRB and ECRL Presentation: Pain and/or Swelling 4 to 6 cm proximal to Lister's tubercle -- Crepitus and *"Squeaking"*--
PIP flx/ext ROM
100-110 deg 0 deg
Normal radial inclination angle
15-20 deg compared to mid shaft of radius
Thumb CMC flx/radial abd/palmar abd
20 deg 50-55 deg 50-55 deg
pneumonic for determining number of tendons in each compartment of wrist
221211
least mobile phalanx
2nd and 3rd digit
thumb MCP flx/ext
50-55 deg 0 deg
DIP flexion
70-80 deg
thumb IP flx/ext
80-85 deg 0 deg
ROM MCP flx/ext ABD/ADD
85-90 deg 30-45 deg 20-30 deg 0 deg
Stener lesion
A complication of UCL injury to the thumb in which the adductor aponeurosis gets caught between the ruptured ends of the ligament and prevents healing
Boutonniere deformity
A tear of the extensor tendon of the PIP joint, at the middle of the finger, and the DIP joint that controls the fingertip. PIP flx -> DIP ext
most common location for trigger finger
A1 pulley
most important pulleys in hand
A2 & A4 at proximal and middle phalanges maintain mechanism of pulley system
dorsal interossei action
Abduction of digits 2-4 at MTP joint Flexion of digits 2-4 at MTP joints Extension of digits 2-4 at IP joints
muscles in first wrist compartment
Abductor pollicus longus (APL) - rad abd of thumb extensor pollicus longus (EPL) - MP ext of thumb
palmar interossei action
Adduction of digits 2, 4, and 5 at MCP joints Flexion of digits 2, 4, and 5 at MCP joints Extension of digits 2, 4, and 5 at PIP joints Extension of digits 2, 4, and 5 at DIP joints
Ape Hand
Damage to the median nerve; deformity in which people cannot move thumb away from rest of hand.
pain to 1st dorsal compartment
De Quervains tendon rupture
pain to 3rd dorsal compartment
EPL tendon rupture
6th wirst compartment
Extensor Carpi ulnaris (ECU) - important stabiliser
2nd wirst compartment
Extensor carpi radialis longus (ECRL) Extensor carpi radialis brevis (ECRB)
5th wrist compartment
Extensor digiti quinti (EDQ) - MP, PIP jt ext of small finger
4th wrist compartment
Extensor digitorum (ED) - MP and PIP jt ext Extensor indicis (EI)- MP and PIP jt ext of 2nd digit
3rd wrist compartment
Extensor pollicus longus (EPL) - thumb IP jt ext
ms that attaches to pisiform
FCU
lumbricals action
Flexion of digits 2-5 at MTP joints Extension of digits 2-5 at IP joints
DeQuervain's Tenosynovitis
Inflammation of the abductor pollicis longus and extensor pollicis brevis, resulting in pain, crepitation and swelling over the radial styloid, Finklestein's test is typically positive Conservative intervention includes: activity modification orthotic positioning tendon gliding exercises ergonomic education
pain to lunate
Kienbock disease dislocation/sublux fx
opposition
Movement of the thumb to touch the fingertips req median nerve function
pain to 1st CMC jt
OA
pain to DRUJ
OA instability TFCC injury
Bouchard's nodes
Osteoarthritis (PIP swelling 2° to osteophytes)
straight fist
Placing fingertips on the thenar and hypothenar eminences
Heberden's nodes
Swelling of distal interphalangeal finger joints, characteristic of osteoarthritis
positive ulnar variance
Ulna is too long. TFC (triangular fibrocartilage complex) can be damaged.
Negative ulnar variance
Ulna is unusually shorter than the radius, seen with scapho-lunate dislocation or Kienbock's disease
Raynaud's disease
a peripheral arterial occlusive disease in which intermittent attacks are triggered by cold or stress
hypothenar intrinsic muscle action
abductor digiti minimi, flexor digiti minimi, oponens digiti minimi
thenar eminence muscles
abductor pollicis brevis, flexor pollicis brevis, opponens pollicis
Finger Extension Test
also called *Shuck Test* Procedure: Hold the pt's *wrist in a flexed position with fingers extended -> Apply pressure to extended fingers & ask patient to resist the motion -> Bilaterally performed (+) *pain in the wrist* Indicates: radiocarpal, midcarpal or scaphoid instability, inflammation or Kienbock's disease
canal of guyon (ulnar canal)
between pisiform and hook or hamate
hook fist
differential gliding FDS/FDP
ulnar claw hand
distal ulnar nerve lesion, ulnar deviation of wrist upon wrist flexion; loss of MEDIAL lumbrical function; 4th and 5th digits are clawed
positive piano key sign
dorsal translation of ulna at DRUJ due to dorsal radioulnar ligament disruption
attachment to hook of hamate
flexor retinaculum
MP joints should be splinted in:
full flexion
pain to Hamate
fx
pain to hook of hamate
fx
pain to scaphoid tubercle
fx
pain to scaphoid (anatomical snuffbox)
fx AVN scapholunate ligament injury
pain to ulnar styloid and ulnar head
fx DRUJ injury
pain to radial styloid process may be indicative of
fx De Quervains OA radial nerve neuritis
pain to lister's tubercle
fx EPL tendon injury
pain to triquetrum
fx lunotriquetral ligament injury TFCC injury
pain to pisiform
fx pisotriquetral OA
pain to 5th digit
fx sprain volar plate injury
pain to 2-4th fingers
fx sprain volar plate injury bossing (CMC jt)
pain to thumb indicative of
fx sprain/tendon injury Gamekeeper's thumb
pain to capitate and capitulolunate jt
fx sublux/dislocation dissociation with or without OA
cylinder grip
holding round object
Swan neck deformity
hyperextension of PIP joint and flexion of DIP joint
Finkelstein's test
identifies deQuervain's tenosynovitis (parentendonitis of abductor pollicis longus and/or extensor pollicis brevis (AbPL + EPB) grip thumb and ulnarly deviate wrist (+) pain
Gamekeeper's thumb
injury to the thumb that results in tearing or stretching of the MP joint or rupture of the ulnar collateral ligament
intrinsic palmar ligaments
interosseous ligament found between 2 adjacent bones
Identifying scaphoid dysfunction on radiograph
lateral radiograph will have an excessively flexed position > 60 deg
lunate dysfunction on radiograph
lateral view - exaggerated tilting of lunate - indicative of local ligament disruption
pain to scapholunate jt
ligament injury dissociation ganglion cyst
pain to lunotriquetral jt
ligament injury or dislocation
most common carpal dislocation
lunate
Dorsal Intercalated Segment Instability (DISI)
lunate tilted dorsally, indicating damaged ligament, likely scapholunate ligament
Volar Intercalated Segment Instability (VISI)
lunate tilted volarly, indicating soft tissue disruption within carpals
full composite fist
maxFDP tendon glide
DISI/VISI symptoms
pain with wrist extension loss of strength pressure pain on scapholunar jt
2 strongest ligaments of the 1st CMC jt
palmar oblique ligament dorsoradial ligament
pain to TFCC
possible tear of articular disk ligament disruption DRUJ disruption
1st CMC grind test
procedure: compress 1st metacarpal into trapezium asian axial load -> rotate metacarpal (+) pain
Depuytren's contracture
progressive disease in which the fascia in the palm of the hand becomes thickened and shortened
extrinsic palmar ligaments
provide the majority of the wrist stability originate for radius/ulna into the carpals to the metacarpals
Scapholunate ballottment test
purpose: SL dissociation procedure: pronated foremarm -> stab lunate -> grap scaphoid at tubercle and proximal pole-> move scaphoid on lunate dorsally and volarly (+) laxity, crepitus, sx reproduction
Scaphoid Shift Test
purpose: SL jt dissociation, SL ligament injury procedure: with finger on scaphoid tubercle -> ulnarly deviate and ext pt's wrist -> apply dorsal pressure to scaphoid tubercle -> move wrist into rad dev and slight flx (+) clunk and reproduction of pt's sx
neutral variance
radial border of ulna in line with ulnar border of radius
Nail observations
redness - infection pallor - vascular disorder, Raynaud's disease bluish - cyanosis - venous occlusion dryness - peripheral nerve lesion clubbing - pulmonary or inflammatory bowel disease spoon shaped nails - iron deficiency, lupus, Raynaud's disease
Kienbock's disease
refers to the necrosis of the lunate, which may develop after trauma
Key/3-pt pinch Grip
req ulnar, AIN, and median nerve function
When making a fist, all the fingers should point to which bone?
scaphoid
most fractured carpal bone
scaphoid
bones of the wrist
scaphoid, lunate, triquetrum, pisiform, trapezium, trapezoid, capitate, hamate
most commonly injured ligament in the wrist
scapholunate
Grip Dynamometer Test
strength test that measures force development by the finger flexors during an isometric action 5 positions create a bell curve of strength that identifies median/ulnar nerve injury
volar ligament of DRUJ is taut in
supination
Pain to scaphoid-trapezium-trapezoid jt
synovitis OA
MCP collateral ligaments are ____ in flexion and ______ in extension
taut lax
pain to 5th and 6th dorsal compartments
tendon injury ECU sublux
pain to 2nd-4th dorsal compartments
tenosynovitis impingement beneath extensor retinaculum tendon rupture
pain to wrist and finger flexor tendons
tenosynovitis trigger finger tendon injury Depuytren's contracture
most stable articulation of carpals
trapezium
pain to distal ulnar tunnel
ulnar nerse syndrom nerve/artery injury
hyperextension injury of PIP jt can lead to
volar plate avulsion and dislocation from distal insertion