Revision as of 18:53, 20 March 2011

Welcome to Temple University's Evidence-Based Practice project. This project was created by and for the students at Temple University in Philidelphia, and is part of the Orthopaedic curriculum. Please do not edit unless you are involved in this project, but please come back in the near future to check out new information!!

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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 <o:p></o:p>

Mechanism of the injury-<o:p></o:p>

How the injury occurred and what was the cause.<o:p></o:p>

Location of the pain<o:p></o:p>

Timeline- <o:p></o:p>

When is the pain at its worse and when is it relieved?<o:p></o:p>

Presence and location of numbness and tingling<o:p></o:p>

Aggravating and relieving factors<o:p></o:p>

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. <o:p></o:p>

Infections<o:p></o:p>

Heat <o:p></o:p>

Swelling<o:p></o:p>

Pain <o:p></o:p>

Redness <o:p></o:p>

Inflammation

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Top five physical findings which are most useful in screening for wrist fracture.¹ <o:p></o:p>

===

Localized tenderness (Sensitivity [Sn] 94%)<o:p></o:p>

Pain on active motion (Sn 97%)<o:p></o:p>

Pain on passive motion (Sn 94%)<o:p></o:p>

Pain on grip (Sn 71%)<o:p></o:p>

Pain on supination (Sn 68%)<o:p></o:p>

Bottom line: Any one of the above findings associated with a history of trauma should be sent for radiographs <o:p></o:p>

Colles fracture<o:p></o:p>

            Scaphoid fracture<o:p></o:p>

Additional potentially serious conditions <o:p></o:p>

Scapholunate instability <o:p></o:p>

            Arthritedes <o:p></o:p>

            Rheumatoid Arthritis<o:p></o:p>

            Lyme disease <o:p></o:p>

            Tuberculosis<o:p></o:p>

            <o:p></o:p>

Peripheral Vascular Disease<o:p></o:p>

Peripheral Neuropathy:<o:p></o:p>

Hx: Older age, >65. The risk is same for men/women.<o:p></o:p>

Risk factors include hypertension, hypercholesterolemia, obesity, diabetes, and smoking. Commonly affects lower extremity over upper extremity.<o:p></o:p>

Upper extremity nerve injuries involving<o:p></o:p>

Median<o:p></o:p>

Radial<o:p></o:p> Ulnar

=[edit | edit source]

<span style=""

<o:p></o:p>

===

Differential Diagnosis
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Carpal Tunnel Syndrome

<o:p></o:p>

Anterior Interosseous Syndrome<o:p></o:p>

[[../../../../index.php5?title=Posterior_Interosseus_Syndrome|Posterior Interousseous Syndrome]]

<o:p></o:p>

Fractures <o:p></o:p>

Distal Radial Fractures

<o:p></o:p>

Osteoarthritis<o:p></o:p>

First Carpometacarpal Osteoarthritis<o:p></o:p>

Thumb CMC grind test

<o:p></o:p>

Hand and Wrist Osteoarthritis

<o:p></o:p>

DeQuervain Syndrome<o:p></o:p>

Finklestein ’s Test :

<o:p></o:p>

Radial Tunnel Syndrome <o:p></o:p>

Compression of the Ulnar nerve at Guyon’s canal<o:p></o:p>

Non-specific wrist pain (mechanical wrist pain)<o:p></o:p>

Can include wrist strain, sprain, joint dysfunction, repetitive injuries or h/o trauma without specific identified diagnosis. <o:p></o:p>

<o:p></o:p>

Trigger Finger<o:p></o:p>

Complex Regional Pain Syndrome

<o:p></o:p>

Triangular Fibrocartilaginous Complex <o:p></o:p>

Dupuytren ’s Contracture

Outcome Measures
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DASH: <o:p></o:p>

Quick DASH <o:p></o:p>

Symptom Severity Scale<o:p></o:p>

Patient Specific Functional Scale <o:p></o:p>

<o:p></o:p>

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

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 = History <br>  =

Wrist and Hand Examination: Difference between revisions

Revision as of 18:53, 20 March 2011

Contents

Subjective[edit | edit source]

History
[edit | edit source]

Red Flags
[edit | edit source]

=[edit | edit source]

Differential Diagnosis
[edit | edit source]

Outcome Measures
[edit | edit source]

Objective[edit | edit source]

Observation[edit | edit source]

Functional Tests
[edit | edit source]

Palpation[edit | edit source]

Neurologic Assessment
[edit | edit source]

Movement Testing[edit | edit source]

Special Tests[edit | edit source]

References[edit | edit source]

Physiopedia

Content

Legal

Wrist and Hand Examination: Difference between revisions

Revision as of 18:53, 20 March 2011

Subjective[edit | edit source]

History [edit | edit source]

Red Flags[edit | edit source]

=[edit | edit source]

Differential Diagnosis [edit | edit source]

Outcome Measures [edit | edit source]

Objective[edit | edit source]

Observation[edit | edit source]

Functional Tests[edit | edit source]

Palpation[edit | edit source]

Neurologic Assessment [edit | edit source]

Movement Testing[edit | edit source]

Special Tests[edit | edit source]

References[edit | edit source]

Our Partners

Physiopedia

Content

Legal

History
[edit | edit source]

Red Flags
[edit | edit source]

Differential Diagnosis
[edit | edit source]

Outcome Measures
[edit | edit source]

Functional Tests
[edit | edit source]

Neurologic Assessment
[edit | edit source]