Red Flags-Wrist/hand
More red flags
Background/Complaints
Tests
Other Wrist Conditions
100

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 

100

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 

100
If someone is complaining of numbness and tingling in the middle of their hand that sometimes goes into their thumb, what pathology are we suspecting? What other sxs might this person have? 

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

100

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

100

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 

200

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

200

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)

200

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 

200

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)

200

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 

300

When is someone likely to have a distal ulna fracture?

Usually occurs with distal radial fractures and TFCC injuries 

300

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 

300

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 

300

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 

300

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 

400

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

400

What are the 4 cardinal signs of infection in the flexor tendon sheath?

1. flexed posture of the digit

2. uniform swelling of the digit

3. tenderness over the length of tendon sheath

4. severe pain on attempted hyperextension of the digit 

400

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 

400

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  

400

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

500

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 

500

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.

500

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 

500

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 

500

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