Wrist and Hand Examination: Difference between revisions
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<br>Trigger Finger<br> Complex Regional Pain Syndrome <br>Triangular Fibrocartilaginous Complex <br>Dupuytren’s Contracture<br><br> | <br>Trigger Finger<br> Complex Regional Pain Syndrome <br>Triangular Fibrocartilaginous Complex <br>Dupuytren’s Contracture<br><br> | ||
= Outcome Measures <br> = | = Outcome Measures <br> = | ||
*DASH: | |||
*Quick DASH | |||
*Symptom Severity Scale | |||
*Patient Specific Functional Scale | |||
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== Objective == | == Objective == |
Revision as of 19:08, 20 March 2011
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Subjective[edit | edit source]
Thorough history taking is an important first step in treating the patient. Each physical therapist will develop their own style and technique, but a good interview will include the basic elements discussed below.
History
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Clinical Presentation
Mechanism of the injury-
How the injury occurred and what was the cause.
Location of the pain
Timeline-
When is the pain at its worse and when is it relieved?
Presence and location of numbness and tingling.
Aggravating and relieving factors.
Were any diagnostic test/imaging performed and what were the results?
Red Flags
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This section deals with screening the patient for possible serious pathologies that could cause wrist or hand pain. These conditions could warrant a referral, or consultation.
Infections
- Heat
- Swelling
- Pain
- Redness
- Inflammation
Fracture/dislocation:
Top five physical findings which are most useful in screening for wrist fracture.1
- Localized tenderness (Sensitivity [Sn] 94%)
- Pain on active motion (Sn 97%)
- Pain on passive motion (Sn 94%)
- Pain on grip (Sn 71%)
- Pain on supination (Sn 68%)
- Bottom line: Any one of the above findings associated with a history of trauma should be sent for radiographs
Colles fracture
Scaphoid fracture
Additional potentially serious conditions
- Scapholunate instability
- Arthritedes
- Rheumatoid Arthritis
- Lyme disease
- Tuberculosis
Peripheral Vascular Disease
Peripheral Neuropathy:
- Hx: Older age, >65. The risk is same for men/women.
- Risk factors include hypertension, hypercholesterolemia, obesity, diabetes, and smoking. Commonly affects lower extremity over upper extremity.
Upper extremity nerve injuries involving
- Median
- Radial
- Ulnar
Differential Diagnosis
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Carpal Tunnel Syndrome
Anterior Interosseous Syndrome
Posterior Interousseous Syndrome
Fractures
- Distal Radial Fractures
Osteoarthritis
- First Carpometacarpal Osteoarthritis
- Thumb CMC grind test
- Hand and Wrist Osteoarthritis
DeQuervain Syndrome
- Finklestein’s Test:
Radial Tunnel Syndrome
Compression of the Ulnar nerve at Guyon’s canal
Non-specific wrist pain (mechanical wrist pain)
- Can include wrist strain, sprain, joint dysfunction, repetitive injuries or h/o trauma without specific identified diagnosis.
Trigger Finger
Complex Regional Pain Syndrome
Triangular Fibrocartilaginous Complex
Dupuytren’s Contracture
Outcome Measures
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- DASH:
- Quick DASH
- Symptom Severity Scale
- Patient Specific Functional Scale
Objective[edit | edit source]
Observation[edit | edit source]
- Posture
- Movement Patterns
Functional Tests
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Palpation[edit | edit source]
- supine
- prone
- seated
Neurologic Assessment
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Movement Testing[edit | edit source]
- AROM, PROM, and Overpressure
- Passive Intervertebral Motion
- Muscle Strength