Difference between revisions of "Hand and Wrist Examination"

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Revision as of 20:34, 10 October 2020

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Dorsal Wrist Pain

Dorsal-wrist-pain.jpg

A = Intersection syndrome
B = De Quervain’s tenosynovitis
C = Scaphoid fracture / Wartenbergs syndrome (nerve entrapment)
D = Base of thumb arthritis
E = Ulnar collateral ligament injury
F = Carpal boss
G = Scapholunate ligament tear
H = Keinbock’s disease
I = Lunotriquetral ligament tear
J = DRUJ (distal radioulnar joint) arthritis / instability
K = Ulnar impaction / TFCC tear
L = ECU dislocation / tendonitis

Volar Wrist Pain

Volar-wrist.jpg

A = FCU tendonitis
B = Pisiotriquetral arthritis / Ulnar nerve entrapment / ulnar artery thrombosis
C = Hook of hamate fracture
D = Trigger finger
E = Base of thumb arthritis

Differential Diagnoses

Acute Wrist Pain

  • Distal radius fracture (often intra-articular in the athlete)
  • Scaphoid fracture
  • Wrist ligament sprain/tear (intercarpal, scapholunate, lunotriquetral)
  • Fracture of hook of hamate
  • Triangular fibrocartilage complex tear
  • Distal radioulnar joint instability
  • Scapholunate dissociation
  • Carpal dislocation
  • Anterior dislocation of lunate
  • Perilunar dislocation
  • Traumatic ulnar artery aneurysm or thrombosis (karate)
  • Dorsal wrist pain - Scaphoid fracture, Scaphoid impaction syndrome, Fracture dislocation of carpus, Lunate fracture, Distal radius fracture, Scapholunate ligament tear, Kienbock's disease (acute onset), Lunotriquetralligament tear, Distal radioulnar joint injury, Carpometacarpal dislocation
  • Volar wrist pain - Carpal instability, Hook of hamate fracture

Subacute Dorsal Wrist Pain

  • Ganglion
  • Intersection syndrome
  • Kienbock's disease
  • Dorsal pole of lunate and distal radius impingement (gymnasts)
  • Posterior interosseous nerve entrapment
  • Inflammatory arthropathy
  • Degenerative joint disease
  • Extensor carpi ulnaris tendinopathy
  • Extensor carpi ulnaris subluxation
  • Injuries to distal radial epiphysis (children)
  • Extensor pollicis longus impingement on Lister's tubercle (occasional rupture)

Subacute Volar Wrist Pain

  • Scaphoid aseptic necrosis
  • Stenosing tendinopathies
  • Flexor carpi ulnaris tendinopathy
  • Carpal tunnel syndrome
  • Ulnar tunnel syndrome
  • Pisotriquetral degenerative joint disease
  • Avascular necrosis of the capitate (weightlifters)
  • Extensor pollicis longus impingement/rupture (gymnasts)

Subacute Ulnar Wrist Pain

  • Triangular fibrocartilage complex tears
  • Ulnar Impaction syndrome
  • Distal radioulnar joint instability
  • Carpal instability
  • Scapholunate dissociation
  • Ulnar nerve compression (cyclists, golfers)
  • Flexor carpi ulnaris tendinopathy
  • Extensor carpi uinaris tendinopathy
  • Extensor carpi ulnaris subluxation
  • Distal radioulnar joint impaction syndromes (golfers)
  • Scaphoid impaction syndrome

Subacute Radial Wrist Pain

Carpal Tunnel Syndrome

  • Cervical radicular pain (C6 or C7): Neck pain, positive Spurlings test
  • First Carpometacarpal Joint Osteoarthritis : Painful thumb motion, positive grind test, radiographic findings
  • De Quervain Tendinopathy: Tenderness distal radial styloid
  • Polyneuropathy: History of diabetes mellitus, bilateral, lower extremity involvement.
  • Thoracic Outlet Syndrome: ulnar sided symptoms, positive EAST and ULTT.
  • Pronator teres syndrome (median nerve compression at the elbow): Forearm pain; sensory loss over the thenar eminence; weakness with thumb flexion, wrist extension, and forearm pronation
  • Ulnar neuropathy: Paresthesias of the ring and little fingers, positive Tinel sign and compression tests at the elbow or wrist (Guyon canal)
  • Radial neuropathy
  • Raynaud syndrome:Symptoms related to cold exposure, typical color changes
  • Vibration white finger:Use of vibratory hand power tools, symptoms of Raynaud phenomenon
  • Wrist osteoarthritis: painful wrist motion, radiographic findings
  • Inflammatory arthropathy
  • Peripheral nerve tumour
  • Multiple sclerosis
  • Amyotrophic lateral sclerosis
  • Acute compression syndromes (eg, Saturday night palsy)