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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

Wrist, Hand, & FingersInjury Assessment

HEAT 4685

Chapter 15, p.519

clinical anatomy p 519
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
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
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
Clinical Anatomy p. 528
  • Carpal Tunnel
    • Fig. 15-8, p. 528
    • Transverse ligament
    • 10 structures pass through tunnel
evaluation history p 528
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
History--p. 528
  • PMH
    • systemic disease (diabetes, rheumatoid arthritis, etc)
    • other upper extremity/cervical spine injury?
observation inspection p 530
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
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
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
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
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
Pathologies
  • Wrist/Hand
  • Fingers
  • Thumb
wrist hand sprains p 553 table 15 5
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
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
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
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
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
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
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
metacarpal fx p 559 table 15 11 p 560
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
boutonniere deformity p 560
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
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
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
bennett s fx p 563
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
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
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
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