Anatomy
Triangular depression found on the lateral aspect of dorsum of hand.
What is anatomical snuffbox (also known as radial fossa)?
Patient referred to OT with diagnosis of lateral epicondylitis. Patient received two steroid injections with minimal reduction in symptoms. Mild pain reported over lateral epicondyle with palpation and majority of pain localized to extensor wad (~4-5 cm distal to lateral epicondyle). Pain elicited with resisted supination and middle finger extension test is positive. You suspect what?
What is Radial Tunnel Syndrome?
I am the most common hand fracture and involves the "neck" of the bone next to the knuckle joint. I am commonly called the Boxer's fracture because I am caused most often by punching or striking a hard object when the hand is closed in a fist. Who am I?
What is 5th metacarpal fracture?
Stenosing tenosynovitis in the first dorsal compartment of the wrist which contains the APL and EPB tendons. The Finkelstein Test is usually positive.
What is De Quervain's?
Examiner grips the thumb metacarpal and moves the thumb in circular motion while applying a gentle axial load to the CMC joint. Positive test usually indicates pain and crepitus is elicited. (Hint: Suggestive of CMC arthritis)
What is CMC Grind Test?
Long, slender tendon present (if present) in volar aspect of forearm in between FCR and FCU tendons. It is known to be absent in ~14-30% of population.
What is palmaris longus tendon?
Patient is referred to OT s/p CMC arthroplasty. Patient was fitted with post op plaster orthosis. During the OT evaluation, patient reports symptoms of burning pain and numbness along dorsal radial aspect of the thumb (anatomical snuffbox), increased edema and complains the post op cast was "too tight." You suspect what?
What is compression of radial sensory nerve?
I am the most common wrist fracture and usually happens when people try to catch themselves during a fall and land hard on an outstretched hand. Who am I?
What is distal radius fracture?
Stenosing tenosynovitis of the digits that occurs more often in women and higher incidence in patients with diabetes, gout, and rheumatoid arthritis.
What is trigger finger?
Examiner asks the patient to hold a paper between the thumb and side of index finger (lateral pinch) and attempts to remove/pull the paper. Positive test elicits flexion of the IP joint of the thumb.
What is Froment's Test/Sign?
I am long with a narrowed waist giving me a "boat-shaped" appearance. I sit next to the trapezium. Who am I?
What is scaphoid?
Patient presents to OT with a diagnosis of distal radius fracture s/p ORIF. Pt complains of hand pain following traumatic FOOSH. Patient presents with pain, allodynia, increased edema, trophic changes in nail and hair growth, and abnormal blood flow (sudomotor activity) in the region of pain. In addition to the original diagnosis of ORIF of distal radius, you suspect what?
What is CRPS?
Deformity of the finger characterized by hyperextension of the PIP joint and flexion of the DIP joint.
What is Swan Neck Deformity?
Tendinitis affects one of the most important stabilizers of the DRUJ. This tendon passes through the extensor retinaculum and has a separate sheath that is formed around it.
What is ECU tendinitis?
Examiner holds the patient's wrist in ulnar deviation while applying a longitudinal load to the 4th and 5th metacarpals. Positive test elicits pain at the TFCC.
What is TFCC Load Test?
This structure in the hand/wrist consist of 4 anatomical features: ECU sub sheath, UCL, dorsal/volar ligaments of DRUJ, and meniscus homologue.
What is TFCC?
OT wants to quickly assess ulnar nerve function in the hand. What muscle would they test?
What is dorsal interossei?
This injury/deformity occurs frequently when an individual jams the finger, resulting in flexion of the PIP joint and hyperextension of the DIP joint.
What is Boutonniere Deformity?
A rare condition that may need MRI to confirm. Usually affects the first and second compartments of the extensor retinaculum and results from repetitive friction at the junction in which tendons of the first dorsal compartment cross over the second compartment. Symptoms commonly seen in tennis players, weight lifters, or rowers and aggravated by repetitive wrist flexion and extension. (Hint: often called "squeaky wrist")
What is Intersection Syndrome?
With patient's forearm in pronation and hand stabilized in neutral, examiner applies pressure in a downward direction over ulnar head with counter pressure over the volar side and then release pressure. Positive test elicits excessive joint laxity, loss of normal end feel and pain. (Hint: Suggestive of injury to TFCC or DRUJ)
What is Piano Key Test?
The only intrinsic hand muscle that originates and inserts into tendon. Also known as "workhorses" of the hand.
What is lumbrical muscle?
Patient referred to OT with intra-articular proximal phalanx fracture. PIP joint is resting in flexion. OT holds PIP joint in passive extension while attempting to flex DIP joint with limited DIP flexion. OT then holds PIP in full flexion and notes DIP flexion is greater with PIP flexion vs. PIP extension. You suspect what?
What is ORL (oblique retinacular ligament) tightness?
Fracture caused by a direct blow to the bent thumb during contact sports or trauma from forced abduction of first metacarpal.
What is Bennett's fracture?
Stenosing tenosynovitis in volar aspect of wrist with pain localized to the trapezium. Pain with resisted wrist flexion. Often misdiagnosed with variety of conditions (i.e. CMC arthritis, De Quervain's, STT arthritis).
What is FCR tendinitis?
Examiner gives pressure over the scaphoid with his/her thumb in dorsal direction and other hand grasps the metacarpal from ulnar side while moving the wrist in ulnar deviation and slight extension. Then the examiner gradually moves the wrist into radial deviation and slight flexion, while keeping pressure on the scaphoid. Examiner then removes pressure over the scaphoid. Positive test elicits a "clunk" that can be heard or felt when pressure is removed from scaphoid. Positive test usually suggestive of injury to SL ligament.
What is Watson/Scaphoid Shift Test?