1 / 33

Wrist, Hand, & Fingers Injury Assessment

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

nakia
Download Presentation

Wrist, Hand, & Fingers Injury Assessment

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Wrist, Hand, & FingersInjury Assessment HEAT 4685 Chapter 15, p.519

  2. 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)

  3. 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

  4. 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

  5. Clinical Anatomy p. 528 • Carpal Tunnel • Fig. 15-8, p. 528 • Transverse ligament • 10 structures pass through tunnel

  6. 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

  7. History--p. 528 • PMH • systemic disease (diabetes, rheumatoid arthritis, etc) • other upper extremity/cervical spine injury?

  8. 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

  9. 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)

  10. 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

  11. 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)

  12. 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

  13. Pathologies • Wrist/Hand • Fingers • Thumb

  14. Wrist/Hand Pathologies

  15. 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

  16. 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

  17. 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

  18. 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

  19. 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

  20. 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

  21. 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

  22. Navicular/scaphoid fracture--p.556

  23. 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

  24. Finger Pathologies--p.560

  25. 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

  26. 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

  27. 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

  28. IP Dislocations--

  29. Thumb Pathologies--p.562

  30. 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

  31. 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

  32. 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

  33. Thumb sprains--

More Related