Red Flags-Wrist/hand
What are some common signs and symptoms in general of undiagnosed fractures or the wrist?
Pain is worse at night, pain is constant, some fxs may be able to be detected with vibration (tuning fork), symptoms are not improving with PT, inability to bear weight through involved extremity
What is the most common fracture in the whole body? What are the 2 types?
Distal phalanx fracture
Its very painful, can develop hypersensitivity, subungual hematoma and trauma to nail bed
Types:
Tuft: simple and comminuted
Shaft: longitudinal and transverse
Carpal tunnel syndrome
May also have pain in the median nerve distribution, symptoms will be worse at night and disturb sleep, wrist pain at end ranges of activities, aggravated by wrist flexion or extension and they might frequently drop things or have trouble picking up small objects
What is the ICF category for carpal tunnel syndrome? What are the tests we would perform?
Hand pain with sensory deficits
Tests: wrist flexion median nerve compression test, phalen's test, tinel to carpal tunnel, Median nerve ULNT
What is a Colles fracture? What is it caused by? What are the common complaints?
Wrist pain associated with traumatic event- dorsal displacement of distal radius
Usually caused by FOOSH
Common complaints: wrist pain, inability to us hand and wrist, tenderness in distal wrist, visible deformity
What are some common signs of a distal radius fracture? What do we do if we suspect it?
Pain and tenderness along distal radius, swelling, bone bowing (children)
They need to be referred for radiography
What is Raynaud's phenomenon? What would you find in an exam of someone with this?
Episodic color changes of extremities in response to cold exposure or emotional stress
Exam findings: pallor, cyanosis, taking medications promoting vasoconstriction (B-blockers, amphetamines, decongestants and caffeine)
What pathology might we suspect if a pregnant women has pain when gripping or lifting objects. The pain is located more on the top part of the thumb.
De Quervain's Syndrome
What ICF category is De Quervain's Syndrome? What are the tests we would do? What structures are being tested?
Thumb pain with muscle power deficits
Tests: Finkelstein's test- puts stress on the APL (abductor pollicis longus) and EPB (extensor pollicis brevis)
What is a Smiths fracture?
The reverse of a Colles fracture- palmar (volar) displacement of the distal radius and hand
Presentation is similar to Colles fracture
When is someone likely to have a distal ulna fracture?
Usually occurs with distal radial fractures and TFCC injuries
What are the types of long flexor tendon injuries? What would you find in an exam? What is the intervention?
Open (laceration): trauma (GSW, knife), skin, nerve and artery damage, multiple digits might be involved
Closed (forced flexion): forced flexion with resistance, MOST COMMON, can be pathological (RA), rupture may occur
Exam findings: unable to actively flex digit, palpable deficit in involved muscle, pain, Swelling is RARE
ALWAYS needs surgery
What pathology would you suspect if someone is coming in after a FOOSH with pain in the wrist with grasping and lifting? What other complaints might they have?
Carpal ligament sprain
Other complaints: pain with weightbearing on the wrist, pain with early to mid wrist ROM, visible swelling
What ICF category does carpal ligament sprain fall into? What tests would we perform? What is each test looking at?
Hand pain with movement coordination deficits
Tests:
Ballottement test: assesses the integrity of the lunotriquetral ligament
Watson Scaphoid test: assesses integrity of scapholunate ligament
Intercarpal Accessory mobility: assesses mobility of all the carpal bones
What is Kienbock's disease? What are the stages?
Avascular necrosis of lunate, unknown cause-but may follow trauma, more common in younger adults and children with CP, very rare
Stages:
1. aching and stiffness in the wrist, no radiographic evidence
2. lunate becomes radiodense
3. Deformity of lunate
4. May eventually result in arthritis
What is the most common type of carpal fracture? What is the probable MOA of this fracture? Where would the patient have pain?
Scaphoid fracture
FOOSH
Pain in anatomical snuff box and resisted pronation, swelling over anatomical snuff box
What are the 4 cardinal signs of infection in the flexor tendon sheath?
2. uniform swelling of the digit
3. tenderness over the length of tendon sheath
4. severe pain on attempted hyperextension of the digit
What is the common MOI for thumb UCL sprain? What are some of the common complaints?
Skier's thumb: acute injury of the UCL from trauma (FOOSH with thumb abducted)
Common complaints: difficulty with grasping, pain with use of hand and thumb, pain over thumb MCP
What is the ICF category for thumb UCL sprain? What tests would you perform?
Thumb pain with movement coordination deficits
Tests: thumb valgus stress test
What is Dupuytren contracture? What are ganglion cysts?
Dupuytren: Contracture of palmar fascia causes tendon-like chords, genetic. Usually seen in ring or little finger, palpable nodule and usually bilateral
Ganglion cyst: associated with soft tissue trauma of wrist/hand, can disappear on its own, may impair joint ROM and may cause pain with ROM
What is a boxers fracture? What is the treatment?
Happens when someone punches a solid object with a clenched fist (5th metacarpal fracture is most common)
May require surgery, need to refer out
What is a possible hypothesis for a person who has a history of trauma or immobilization and has stiffness and loss of ROM in their wrist? What are some treatments for this patient?
Wrist Osteoarthritis
We can educate on how common it is to see stiffness after immobilization and use heat before stretching and joint mobilizations. Perform joint mobilization and stretching.
What pathology would you suspect if someone had a previous fall on an outstretched hand and has ulnar sided wrist pain? They also have pain with gripping.
What other complaints might this patient have?
Triangular fibrocartilage complex injury
Other complaints: clicking with wrist pronation and supination, pain with weight bearing on involved wrist
What ICF category does TFCC injury fall into? What are some tests we would do?
Wrist pain with movement coordination deficits
Tests: press test, ulnar deviation and axial compression
Describe Mallet finger, Boutonniere deformity and Swan neck deformity and how they are caused.
Mallet finger: Most common tendon injury in sports, "baseball finger", due to rupture of extensor tendon where it inserts on distal phalanx
Boutonniere deformity: MCP extension, PIP flexion, DIP hyperextension, results from rupture of central slip of the extensor hood
Swan Neck: MCP flexion, DIP flexion, PIP hyperextension, results from contracture of intrinsic muscles or tearing of volar plate