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Chapter 4_Hand and Wrist 157

PHYSICAL FINDINGS IN COMMON CONDITIONS OF THE HAND AND WRIST

Degenerative Arthritis of the Fingers

Heberdens nodes (most common)

Bouchard’s nodes (common)

Mucous cysts (occasional)

Decreased motion at involved interphalangeal joints (common) Instability of involved joints (occasional)

Basilar Joint Arthritis

Swelling and tenderness of the basilar joint

Subluxation of the basilar joint (shuck test) (morę severe cases)

Reduced motion at the basilar joint (palmar abduction, opposition) Weakened opposition and grip strength Abnormal grind test

Hyperextension of the first metacarpophalangeal joint (morę severe cases)

Carpal Tunnel Syndrome

Median nerve compression test abnormal (most sensitive test)

Tinels sign over the median nerve (morę common in early cases) Phalens and reverse Phalens tests reproduce symptoms (variable) Abnormal sensation (two-point discrimination) in the median nerve distribution (morę severe cases)

Thenar eminence softcned and atrophied (morę severe cases)

Weakened or absent opposition (morę severe cases)

De Quervain's Stenosing Tenosynovitis Tenderness and swelling over the first dorsal compartment at the radial styloid

Finkelstein’s test aggravates pain

Ganglion

Palpable mass (may be firm or soft)

Most common locations: the volar hand al the web Flexion crease of the digits or the transverse palmar crease, the dorsal wrist near the extcnsor carpi radialis longus and brevis tendons, the volar wrist near the radial artery Mass transilluminates (larger ganglia)

DupuytrerTs Disease

Palpable nodules in palmar aponeurosis, most commonly affecting the ring fingcr or the little finger

Secondary flexion contracture of the metacarpophalangeal and, occasionally, proximal interphalangeal joint Rheumatoid Arthritis

Boggy swelling of multiple joints (metacarpophalangeal joints and wrist joint most commonly involved)

Boggy swelling of the tenosynovium of the extensor tendons over the dorsum of the wrist and the hand (common)

Boggy swelling of the tenosynovium of the flexor tendons on the volar surface of the wrist (may cause symptoms of carpal tunnel syndrome)(common)

Secondary deformities in morę severe cases, such as ulnar deviation of the metacarpophalangeal joints and swan neck and boutonniere deformities

Secondary rupture of extensor or flexor tendons (variable)

Flexor Tendon Sheath Infection

Cardinal signs of Kanavel present Finger held in PIP flexed position at rest Diffuse swelling of the finger

Tenderness of the volar surface of the finger along the course of the flexor tendon sheath

Pain exacerbated by passive extension of the involved finger Injury to the Ulnar Collateral Ligament of the Metacarpohalangeal Joint of the Thumb (Skier's or Gamekeeper's Thumb)

Swelling and tenderness over the ulnar aspect of the first metacarpophalangeal joint

Pain cxacerbated by strcss of the ulnar collateral ligament Increased laxity of the ulnar collateral ligament (morę severe injuries) Rotational deformity of the thumb (chronię cases)

Ulnar Nerve Entrapment at the Wrist

Compression of the ulnar nerve at Guyons canal reproduces symptoms (most sensitive test)

Abnormal Tinels sign over Guyon’s canal (variable)

Weakness of intrinsic muscles (finger abduction or adduction) (morę severe cases)

Atrophy of the interossei and the hypothenar eminence (morę severe cases)

Abnormal sensation in the little finger and the ulnar aspect of the ring finger (variablc)

Abnormal Fromenfs sign (variable)

Scapholunate Instability

Swelling over the radial wrist

Tenderness of the dorsal wrist over the scapholunate ligament Scaphoid shift test produces abnormal popping and reproduces the patient s pain

Scaphoid shuck test produces increase motion and pain

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