Physical Examination of the Hand & Wrist

 Degenerative Arthritis of the Fingers o Heberdens’ nodes (DIP) o Bouchard’s nodes (PIP) o Mucous cysts (Don’t drain these!!!) o Decreased motion at the involved IP joints o Instability of the involved joint

 Basilar Joint Arthritis o Swelling and tenderness of the thumb CMC joint o achy pain base of thumb o Weakened opposition and grip strength o Abnormal grind test o Subluxation of the basilar joint o Hyperextension of the MP joint

Physical Examination of the Hand & Wrist

 Carpal Tunnel Syndrome o Compression testing o Tinel’s o Phalen’s/Reverse Phalen’s o Decreased light touch o Atrophy of thenar eminence o Weakened APB o Loss of 2 point discrimination (>5mm)

 De Quervain’s Stenosing Tenosynovitis o Tenderness and swelling over the first dorsal compartment at the radial styloid o Finklestein’s test

 Ganglion o Soft or firm rubbery subcutaneous mass that transilluminates o Most common locations . #1 Dorsal wrist (ulnar to ECRB and ECRL) . #2 Volar wrist (ulnar to the radial artery)

 Dupuytren’s Disease o Palpable nodules in the palmar aponeurosis o Most commonly affects 4th and 5th digits o Secondary flexion contractures of the MCP and PIP o Referral to hand surgeon for consultation when unable to flatten hand

Physical Examination of the Hand & Wrist

 Flexor Tendon Sheath Infection/Tenosynovitis o Finger held in flexion o Fusiform swelling (sausage finger) o Tenderness along the entire course of the flexor sheath o Increased pain with passive extension o Infectious vs. Inflammatory

 Trigger Finger o Nodule in the flexor tendon at the A1 pulley o h/o locking/catching o Slides through with flexion and triggers out with extension o Triggers in clinic w/full composite fist

 Ulnar Collateral Ligament Injury (Gamekeeper’s) o History of injury—pulling thumb backwards o Swelling and tenderness over the ulnar aspect of 1st MCP o Pain exacerbated by valgus stress o Increased laxity—compare to contralateral side

Physical Examination of the Hand & Wrist

 Ulnar Nerve Entrapment at the Elbow o numbness/tingling ring/small finger o +/- grip weakness or pinch weakness (Froment’s Sign) o Compression test o Elbow flexion test (>90 degrees flexion=nerve sx ulnar distribution hand) o Tinel’s sign o Weak intrinsic muscles o Atrophy of interossei and hypothenar eminence o Abnormal sensation in the 4th and 5th digit and ulnar dorsum of the hand

 Scaphoid Fracture o Hx of a fall on out stretched hand (FOOSH) injury o Snuffbox tenderness o Distal pole tenderness o Pain with axial compression of the thumb o Have a high index of suspicion!!!

Physical Examination of the Hand & Wrist

 Lacerations o Check FDP and FDS function o 2 point discrimination

 Dorsal wrist pain in young women pearl o Common in young females o no hx of trauma o Unable to pinpoint if it is more radial or ulnar o Have laxity in their wrist and elsewhere . Beighton Hypermobility score o Work on grip strength—OT referral first prior to further w/u