Comprehensive Evaluation of the Wrist, Hand, and Fingers

This detailed assessment covers the history, inspection, palpation, and range of motion tests for the wrist, hand, and fingers to evaluate potential injuries or conditions affecting these areas. Includes information on pain location, deformities, ligament evaluations, and joint movements.

• Evaluation
• Wrist Hand Fingers
• Injury Assessment
• Orthopedic Examination
• Hand Anatomy

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1. The Wrist, Hand, & Fingers JOHN H. ANDERSON, MS, ATC, LAT ASSOCIATE PROFESSOR EMERITUS ATHLETIC TRAINING PROGRAM TROY UNIVERSITY NATA MEMBER FOR OVER 50 YEARS 32NDSTUDENT SEATA MEETING FEBRUARY 25, 2017 STUDENT SEATA MEETING ATLANTA, GEORGIA

2. Evaluation of Wrist, Fingers, & Hand

3. History Location of Pain Mechanism of Injury Relevant Sounds Relevant Sensations Duration of Symptoms Description of Symptoms

4. Inspection General Area Posture of Hand Gross Deformity Palmar Creases Areas of Cuts or Scars

5. Inspection Wrist & Hand Continuity of the Distal Radius & Ulna Continuity of the Carpals & Metacarpals Posture Ganglion Cyst Thumb & Fingers Skin Fingernails Alignment of Fingernails Finger Deformities

6. Palpation of the Hand Metacarpals MCP Collateral Ligaments Phalanges IP Collateral Ligaments Thenar Compartment Thenar Webspace Central Compartment Hypothenar Compartment

7. Palpation of the Hand Ulna Ulnar Styloid Process Ulnar Collateral Ligament Radius Radial Styloid Process Radial Collateral Ligament Lister s Tubercle

8. Palpation of the Carpals Scaphoid Trapezium Lunate Pisiform Hamate Capitate Trapezoid

9. Range of Motion Tests Wrist AROM PROM RROM Flexion Extension Radial Deviation Ulnar Deviation

10. Range of Motion Tests Thumb CMC AROM PROM RROM Flexion Extension Abduction Adduction Opposition

11. Range of Motion Tests Fingers AROM PROM RROM Flexion & Extension MCP Abduction & Adduction MCP Flexion & Extension IP Joints

12. Ligamentous Tests Valgus & Varus Stress Testing - Radiocarpal Joint Glide Testing of Wrist Valgus & Varus Testing IP Joints Ulnar Collateral Ligament - Thumb

13. Neurological Testing Radial Nerve Median Nerve Ulnar Nerve

14. Special Tests Carpal Tunnel Syndrome Phalen s Test DeQuervain s Syndrome Finkelstein Test

15. Other Special Tests Others Tap or Percussion Test Compression Test Long Finger Flexor Test Tinel Test Wrinkle or Shrivel Test Digital Allen Test Bunnel Littler Test Watson Test

16. Signs Murphy s Sign Froment s Sign

17. General First Aid of Wrist & Hand Injuries

18. First Aid Care Ice Splint Soft, Inflated, or Rigid Position of Function Wrist Fingers Sling

19. Injuries to Wrist & Hand

20. Wrist Strain Mechanisms Trauma to musculotendinous unit, due to forcible contraction or stretching, and muscle fatigue Symptoms Pain increased with AROM & passive stretch; loss of function; possible snapping sound upon injury; muscle fatigue prior to injury; pain on RROM; tenderness Signs Muscle spasm; swelling; ecchymosis; point tenderness; loss of function & strength; hematome formation; defect in musculotendinous unit with third-degree injury; inflammation; possible Ca formation with third-degree injury Special Tests AROM, RROM, & passive stretch Referral and Diagnostic Procedures Orthopedist is persistent S/S Classification of Injury First-, second-, third-degree strain

21. Wrist Luxation Common Term Dislocated Wrist Mechanisms Direct trauma causing hyperextension of wrist Symptoms Pain & loss of function Signs Marked deformity; loss of function; swelling; point tenderness Referral and Diagnostic Procedures Orthopedist; X-Ray for possible fracture

22. Wrist Ganglion Common Term Bible Cyst Mechanisms Herniation resulting from minor dorsal or volar capsule sprains of joint capsule through process of mucoid degeneration or herniation of synovial sheath of the flexor carpi radialis tendon sheath, digital extensors, and roof of the first dorsal compartment Symptoms Pain; loss of function; discomfort on use of hand & wrist Signs Appears slowly after injury as a bump on back of wrist. It may appear, then disappear, then reappear. Referral and Diagnostic Procedures Orthopedist; MRI

23. Colles Fracture Common Term Broken Wrist Mechanisms Indirect or direct trauma to the distal forearm by falling on an outstretched hand or hyperextended wrist fracturing the distal end of the radius & ulna Symptoms Sudden pain; los of function; direct & indirect tenderness Signs Loss of function; possible deformity; rapid swelling; direct &/or indirect tenderness; possible bony deviation, crepitus, or false motion; delayed ecchymosis; possible median nerve damage Referral and Diagnostic Procedures Orthopedist; X-Ray

24. Carpal Fracture Mechanism Direct trauma Symptoms Sudden pain; loss of function; direct or indirect tenderness Signs Loss of function; possible deformity; rapid swelling; direct or indirect tenderness; possible tenderness, crepitus, & false motion; delayed ecchymosis Referral and Diagnostic Procedures Orthopedist; X-Ray

25. Tenosynovitis Mechanisms Overuse; direct trauma; repetitive trauma Symptoms Pain on AROM and RROM; pain on passive stretch; loss of function Signs Swelling; thickened tendon in chronic cases; snowball crepitus; inflammation Special Tests AROM; RROM; passive stretch Referral and Diagnostic Procedures Orthopedist if s/s persist

26. Carpal Tunnel Syndrome Mechanisms Compression of median nerve as it passes beneath the flexor retinaculum on the volar aspect of the wrist Symptoms Numbness & tingling in fingers; pain; loss of function Signs Point tenderness at wrist; pain over carpal tunnel; poor finger flexion Special Tests Tinel s sign; Phalen s test; Electromyography; nerve conduction study Referral and Diagnostic Procedures Orthopedist; X-Ray

27. Lunate Luxation Common Term Dislocated Carpal Bone Mechanisms Indirect trauma; fall on outstretched hand or hyperextended wrist Symptoms Pain; loss of function; numbness of flexor muscles due to pressure on median nerve; tenderness Signs Marked deformity; loss of function; swelling; point tenderness; Murphy s sign Referral and Diagnostic Procedures Orthopedist; X-Ray for possible fracture

28. Navicular (scaphoid) Fracture Mechanisms Indirect trauma to an outstretched hand (thumb) or hyperextended wrist Symptoms Sudden pain; loss of function; direct & indirect tenderness Signs Loss of function; rapid swelling; direct tenderness to anatomic snuffbox; indirect tenderness; possible bony deviation, crepitus, & false motion; delayed ecchymosis Special Tests Compress of thumb; pressure into anatomic snuffbox Referral and Diagnostic Procedures Orthopedist; X-Ray

29. Ulnar Collateral Ligament Sprain - Thumb Common Terms Gamekeeper s Thumb or Skier s Thumb Mechanisms Forced abduction & hyperextension of thumb causing sprain of the ulnar collateral ligament Symptoms Pain on AROM, RROM, & passive stress; loss of function; tenderness Signs Point tenderness over ulnar collateral ligament; swelling; hemorrhage; possible deformity with third-degree injury; ecchymosis; possible instability with second- and third-degree injuries; inflammation Special Tests Abduction stress test of thumb Referral and Diagnostic Procedures Orthopedist; X-Ray for possible avulsion fracture of ligament Classification of Injury First-, second-, third-degree

30. Bowlers Hand Common Term Bowler s Thumb Mechanisms Overuse of the thumb, such as in the hole of a bowling ball, causing pressure on the ulnar nerve Symptoms Numbness; pain; tingling Signs Loss of sensation of thumb; loss of strength Referral and Diagnostic Procedures Neurologist is s/s persist

31. DeQuervains Disease Common Term Tenosynovitis of Wrist Mechanisms Extensive wrist motion, as in gripping sports, to the abductor pollicis longus & extensor pollicis brevis tendons & their sheaths at the radial styloid; excessive radial or ulnar deviation; combination of these movements Symptoms Aching; radiating pains into hand & forearm; loss of strength; pain; inability to grip; point tenderness Signs Painful crepitus of the tendon at the base of the thumb; weakness of thumb extension & abduction; parathesia over the dorsum of the thumb; weakness in ulnar deviation; inflammation; possible stenosis of the fibro-osseous canal; possible localized swelling Special Test Finkelstein s Test Referral and Diagnostic Procedures Orthopedist if s/s persist

32. Bennetts Fracture Mechanisms Indirect trauma, such as striking an object with a closed fist on the first metacarpal Symptoms Sudden pain; loss of function; direct or indirect tenderness Signs Loss of function; possible deformity; rapid swelling; direct tenderness at the base of first metacarpal; indirect tenderness; possible bony deviation, crepitus, & false motion; delayed ecchymosis; click felt as joint subluxes Referral and Diagnostic Procedures Orthopedist; X-Ray

33. Ulnar Neuropathy Common Terms Handlebar or Cycle Palsy Mechanisms Irritation of ulnar nerve caused by abnormal pressure on the hands due to excessive body weight forced forward while the wrists are in prolonged extension; pressure on hypothenar eminence & road vibration during cycling Symptoms Loss of strength; pain when riding; pain at rest; decrease in skin sensitivity; sharp burning pain Signs Weakness of motor function; minimal sensory findings; loss of coordination of ulnar nerve in fourth & fifth finger Special Test Ulnar Nerve Motor Test Referral and Diagnostic Procedures Neurologist; EMG study

34. Hamate Fracture Mechanisms Indirect trauma to wrist; fall on outstretched or hyperextended wrist Symptoms Sudden pain; loss of function; direct & indirect tenderness Signs Loss of function; possible deformity; rapid swelling; direct & indirect tenderness; possible bony deviation, crepitus, & false motion; delayed ecchymosis Referral and Diagnostic Procedures Orthopedist; X-Ray; CT Scan

35. Fifth Metacarpal Fracture Common Term Boxer s Fracture Mechanisms Indirect trauma, such as a striking blow with the fist Symptoms Sudden pain; loss of function; direct or indirect tenderness; poor ability to grip Signs Loss of function; inability to grip; possible deformity; rapid swelling; direct & indirect tenderness; possible bony deviation, crepitus, & false motion; delayed ecchymosis Special Tests Axial Load Test Referral and Diagnostic Procedures Orthopedist; X-Ray

36. Mallet Finger Common Term Hammer Finger Mechanisms Longitudinal force to the fingertip; forced flexion of the distal phalanx Symptoms Pain; loss of function; inability to extend distal phalanx Signs Deformity; fingertip is dropped down; possible crepitus; inability to extend distal phalanx; finger carried at 30 degrees Special Tests Range of motion of distal phalanx (extension) Referral and Diagnostic Procedures Orthopedist; X-Ray for possible avulsion fracture

37. Boutonnire Deformity Common Term Buttonhole Deformity Mechanisms Trauma to middle phalanx; forced flexion of the proximal interphalangeal joint; rupture of extensor tendon of the middle phalanx Symptoms Pain at point of injury; loss of function Signs Point tenderness over the dorsal middle phalanx; swelling; flexion deformity of proximal interphalangeal joint; instability to extend the finger; hyperextension of distal joint Special Tests PIP Range of Motion Referral and Diagnostic Procedures Orthopedist; X-Ray for possible fracture

38. Phalange Luxation Common Term Dislocated Finger Mechanisms Direct trauma to joint of a phalanx; indirect force applied to the distal tip of the finger Symptoms Pain; loss of function Signs Marked deformity; loss of function; swelling; point tenderness Referral and Diagnostic Procedures Orthopedist; X-Ray for possible fracture

39. Flexor Digitorum Profundus Tendon Rupture Common Term- Jersey Finger Mechanisms Forced extension of flexed distal phalanx Symptoms Pain; loss of function Signs Swelling; loss of function; pain distal to interphalangeal joints on volar surface; palpable mass on palm of injured hand; lacks full flexion of IP joints when joint is held in extension Special Test Flexor Digitorum Profundus Test Referral and Diagnostic Procedure Orthopedist

40. Thank You!