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