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Wrist, Hand, & Fingers Injury Assessment. HEAT 4685 Chapter 15, p.519. Clinical Anatomy P. 519. Bony Anatomy Radius styloid process Ulna styloid process ulnar head Carpals (8) Proximal row: N, L,T, P Distal row: T,T,C,H Metacarpals (5). Clinical Anatomy p.520. Ligamentous Anatomy

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Wrist, Hand, & Fingers Injury Assessment

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Wrist hand fingers injury assessment l.jpg

Wrist, Hand, & FingersInjury Assessment

HEAT 4685

Chapter 15, p.519


Clinical anatomy p 519 l.jpg

Clinical AnatomyP. 519

  • Bony Anatomy

    • Radius

      • styloid process

    • Ulna

      • styloid process

      • ulnar head

    • Carpals (8)

      • Proximal row: N, L,T, P

      • Distal row: T,T,C,H

    • Metacarpals (5)


Clinical anatomy p 520 l.jpg

Clinical Anatomy p.520

  • Ligamentous Anatomy

    • Radial collateral ligament

      • limits ulnar deviation

      • taut in full flexion & extension

    • Ulnar collateral ligament

      • limits radial deviation

      • taut in full flexion & extension


Clinical anatomy p 5204 l.jpg

Clinical Anatomy p. 520

  • Ligamentous Anatomy

    • Palmar radio-carpal ligament complex

      • limits wrist hyperextension

    • Dorsal radiocarpal ligament

      • only major dorsal ligament

      • limits wrist flexion

    • Palmar ulnocarpal ligament

      • limits hyperextension

    • Intercarpal ligaments

      • maintains alignment of carpals


Clinical anatomy p 528 l.jpg

Clinical Anatomy p. 528

  • Carpal Tunnel

    • Fig. 15-8, p. 528

    • Transverse ligament

    • 10 structures pass through tunnel


Evaluation history p 528 l.jpg

Evaluation: History p.528

  • Location of pain

    • localized pain?

    • radiating pain?

    • referred pain?

  • Mechanism of injury

    • acute vs.. chronic pain

    • hyperflexion vs. hyperextension

  • Sounds & sensations

    • pops/snaps/crepitus

    • numbness/tingling/burning


History p 528 l.jpg

History--p. 528

  • PMH

    • systemic disease (diabetes, rheumatoid arthritis, etc)

    • other upper extremity/cervical spine injury?


Observation inspection p 530 l.jpg

Observation/Inspection--p. 530

  • Posturing of the hand--

    • tendon avulsions/neuro. Injuries

  • Pathological Postures—p.531

  • Obvious deformity in fingers/wrist--

    • dislocations/fractures

    • alignment, knuckles, with/without motion

      • Murphy’s sign

      • Boxer’s fracture


Observation inspection p 5309 l.jpg

Observation/Inspection--p. 530

  • Palmar creases--

    • lost with edema

    • decreased with Down’s Syndrome

  • Lacerations/scars--superficial structures easily damaged

  • Ganglion cysts

  • Thenar/hypothenar eminence (p. 535)


Finger inspection p 532 l.jpg

Finger Inspection—p.532

  • Felon

    • Infection distal to DIP joint

    • Inflammation of distal phalanx

    • Treat with antibiotics

  • Subungual Hematoma

    • Entrapped hematoma

    • Lumina present?

    • Treat quickly to reduce pain

  • Paronychia

    • Peripheral nailbed infection

    • Inflammation with possible drainage

    • Treat with antibiotics and warm soaks


Palpation p 533 536 537 l.jpg

Palpation-- p. 533, 536-537

  • pisiform (5th)

  • hook of the hamate (4th)

  • palmaris longus

    • p. 533, fig. 15-14

    • present?

  • scaphoid

    • navicular

    • “anatomical snuffbox”—p.535, fig. 15-16

  • lunate (dorsal--3rd)


Functional tests p 537 l.jpg

Functional Tests--p. 537

  • Wrist ROM—Box 15-3, p. 538

    • flexion>extension

    • ulnar deviation>radial deviation

  • Thumb ROM—p.543

    • flexion/extension

    • abduction/adduction

    • opposition

  • Finger ROM—Box 15-4, p. 539

    • flexion/extension

    • abduction/adduction


Pathologies l.jpg

Pathologies

  • Wrist/Hand

  • Fingers

  • Thumb


Wrist hand pathologies l.jpg

Wrist/Hand Pathologies


Wrist hand sprains p 553 table 15 5 l.jpg

Wrist/Hand Sprains--p.553 , Table 15-5

  • History:

    • acute onset (FOOSH)

    • excessive ROM

  • Observation

    • occasional localized edema

    • limited AROM in flex/ext (?)

    • (-) x-rays

  • Palpation:

    • localized tenderness

    • usually no deformity or crepitus

  • Examination:

    • all other pathologies r/o

    • Overpressure in PROM

    • no specific laxity testing


Collateral ligament sprains p 548 l.jpg

Collateral Ligament Sprains--p.548

  • History:

    • acute onset (FOOSH)

    • excessive ROM

  • Observation

    • occasional localized edema

    • limited AROM in flex/ext (?)

    • (-) x-rays

  • Palpation:

    • localized tenderness

    • usually no deformity or crepitus

  • Examination:

    • Glide test

      • Box 15-10, p.550

    • Varus/valgus testing

      • fig. 15-9, p. 549


Triangular fibrocartilage complex sprains tfcc 553 table 15 6 p 554 l.jpg

Triangular Fibrocartilage Complex Sprains--(TFCC)—553& Table 15-6, p. 554

  • History:

    • acute onset

    • wrist hyperext. Mechanism

    • often accompanies UCL injury

    • pain inc. with activity

  • Observation:

    • diffuse swelling

    • persistent nagging injury

  • Palpation:

    • Medial jointline tenderness

    • possible UCL tenderness

    • limited extension (AROM & PROM)

  • Examination:

    • (+) valgus stress test

    • (+) glide test


Carpal tunnel syndrome p table 15 7 p 554 l.jpg

Carpal Tunnel Syndrome--p. Table 15-7, p. 554

  • History:

    • usually slow onset

    • usually repetitive stress mechanism

    • c/o tingling & numbness into hand

  • Observation:

    • generalized palmar edema

    • symptoms dec. with altered activity

  • Palpation:

    • generalized palmar tenderness

    • dec. sensation along median nerve dermatome

    • dec. wrist AROM/PROM

    • weakened thumb ABD

  • Examination:

    • (+) Tinel sign at carpal tunnel

    • (+) Phalen’s test

      • fig. 15-13, p. 555


Lunate dislocation table 15 10 p 558 l.jpg

Lunate dislocation--Table 15-10, p. 558

  • History:

    • forced hyperextension (FOOSH)

    • hears/feels a “pop”

    • c/o pain at lateral wrist/hand

    • possible paresthesia

  • Observation:

    • (+) Murphy sign

    • obvious bulge dorsal or palmar

  • Palpation:

    • obvious deformity

    • possible crepitus

      • scaphoid fx?

  • Examination:

    • Palpation

    • x-ray to r/o scaphoid fx


Wrist fractures p 555 l.jpg

Wrist Fractures--p. 555

  • History:

    • FOOSH injury

    • distal radius/ulna pain

    • heard/felt pop

    • immediate loss of function

  • Observation:

    • obvious deformity

    • Colles fx--distal radius moves dorsally

    • Smith’s fx--distal radius moves palmarly

    • Rapid swelling

  • Palpation:

    • obvious deformity

    • Probable crepitus

  • Examination:

    • x-ray referral


Navicular scaphoid fracture p 556 l.jpg

Navicular/scaphoid fracture--p.556

  • History:

    • hyperextension mechanism

    • pain at snuffbox

    • possible crepitus

  • Observation:

    • false (+) x-ray

    • often no significant deformity

  • Palpation:

    • pain at anatomical snuffbox

    • reduced wrist ext. (pain)

    • crepitus possible

  • Examination:

    • x-rays

    • snuffbox tenderness

    • percussion test of thumb--> snuffbox pain

    • monitor for necrosis


Navicular scaphoid fracture p 55622 l.jpg

Navicular/scaphoid fracture--p.556


Metacarpal fx p 559 table 15 11 p 560 l.jpg

Metacarpal fx--p.559 & Table 15-11, p. 560

  • Compression mechanism

  • pop with immediate pain

  • immediate localized swelling/deformity

  • AROM may be possible!

  • (+) percussion test


Finger pathologies p 560 l.jpg

Finger Pathologies--p.560


Boutonniere deformity p 560 l.jpg

Boutonniere deformity--p.560

  • History:

    • mechanism: longitudinal force to phalanx

    • acute or chronic

    • inability to extend PIP

  • Observation:

    • obvious deformity at PIP

    • maintained DIP extension with PIP flexion

  • Palpation:

    • click/pop with AROM at PIP

    • tenderness at dorsal PIP


Finger fractures p 561 l.jpg

Finger Fractures--p.561

  • Mallet finger--

    • dorsal PIP avulsion fx

    • forced flexion from ext.

    • inability to actively ext. PIP

  • Jersey finger

    • palmar PIP avulsion fx

    • forced ext. from flexion

    • inability to actively flex PIP


Dislocations p 551 box 15 11 l.jpg

Dislocations--p.551, Box 15-11

  • History--

    • longitudinal/varus/ valgus stress

    • felt a pop

    • obvious deformity

  • Observation:

    • obvious deformity at IP joint

    • immediate swelling

    • possible fx seen on x-ray

  • Palpation:

    • possible crepitus with AROM & PROM

    • tender at jointline

  • Examination:

    • (+) varus or valgus stress test


Ip dislocations l.jpg

IP Dislocations--


Thumb pathologies p 562 l.jpg

Thumb Pathologies--p.562


Bennett s fx p 563 l.jpg

Bennett’s fx--p. 563

  • History:

    • similar to other metacarpal fx

    • fx at articular surface of CMC

  • Observation:

    • limited AROM

    • fx seen on x-ray

    • severe loss of function

  • Palpation:

    • Tender at CMC jointline

    • Possible crepitus

  • Examination:

    • (+) percussion test

  • May need surgical fixation


Dequervain s syndrome table 15 12 p 562 l.jpg

deQuervain’s syndrome--Table 15-12, p. 562

  • History:

    • gradual onset

    • repetitive stress

    • c/o pain at radial styloid and thenar eminence radiating into forearm

  • Observation:

    • lateral forearm edema (distal radius)

    • dec. AROM at wrist & thumb--esp. deviation

  • Palpation:

    • tenderness at abductor tendons of thumb

    • possible crepitus with radial deviation

  • Examination

    • Finklestein’s test

      • Box 1514, p. 563


Thumb sprains p 562 table 15 13 p 564 l.jpg

Thumb sprains--p.562 & Table 15-13, p. 564

  • History:

    • Gamekeeper’s thumb/skier’s thumb

    • UCL sprain

    • hyperabduction or hyperextension mech.

    • acute or gradual onset

    • c/o medial thumb pain

  • Observation:

    • thenar eminence edema

    • guarded presentation (in adduction)

  • Palpation:

    • possible crepitus with AROM/PROM

    • tenderness at ulnar border of thumb

    • extreme weakness in ADDuction

  • Examination:

    • hyperabduction

    • (+) pinch test

    • x-rays

  • Possible Sx


Thumb sprains l.jpg

Thumb sprains--


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