Examination of the Hand and Wrist: Introduction (05:33)
Jon Englund welcomes participants to his lecture and explains he met Carrie Jaworski while studying at Northwestern University. His talk will cover wrist examination. Englund reviews basic anatomy of the wrist including the bones, ligaments, and tendons.
Wrist Instabilities (02:52)
Learn the difference between a dorsal intercalated instability (DC) and a volar intercalated instability (VC). An oblique wrist view gives physicians an opportunity to better diagnose fractures and osteoarthritis.
MRI Imaging (03:09)
Englund explains the different views of an MRI of the wrist. A wrist examination begins with observing the patient: how they hold the wrist, ability to move, and if there are any deformities, swelling, or atrophy. A Jamar dynamometer can determine the strength of the patient.
Palpate the radial, dorsal, ulnar, and palmar sides of the wrist to determine issues. England explains the technique to examine, by touch, the radial wrist.
Dorsal Wrist (04:52)
Englund demonstrates the technique to palpate the dorsal wrist and cautions it can be difficult to examine the carpometacarpal joints. The ulnar wrist can diagnose triangular fibrocartilage complex injuries.
Ulnar Wrist (02:59)
Pushing on the ulnar styloid can determine if a patient suffers from piano key. Englund explains where to give carpal tunnel injections.
Special Tests (04:28)
Watson's shift, finger extension, compression, drawer, Shuck and Tinel's tests help determine wrist instabilities. England describes how to properly administer the tests and what comprises a positive diagnosis.
Nerve/ Vascular Impingement (01:59)
Englund describes Durken's, Tinel's, and Phalen's tests for nerve compression. Ulnar artery thrombosis occurs in bikers and patients who do repetitive gripping.
Hand Anatomy (04:43)
Jaworski reviews the anatomy of the hand and the importance of determining if the tendons are involved in the Palmer creases. Look at fingers, metacarpophalangeal joints, and interphalangeal joints to diagnose a hand injury. The ulnar nerve allows individuals to give a firm handshake.
Tendons in the Hand (02:46)
Jaworski reviews the extensor and flexor tendons and how to test proximal interphalangeal joint injuries. There are two neurovascular bundles in the hand. The Bunnel-Littler test can determine the tightness of the intrinsics.
Hand Strength Testing (04:13)
Manual strength and Jamar dynamometer can test for strength. Jaworski describes how to palpate a hand to diagnose any injuries. Mallet finger is an injury to the thin tendon that straightens the end joint of a finger or thumb.
Flexor Tendon Injury (03:01)
The tendon can retract down into the wrist; Jaworski recommends referring these type of injuries to a surgeon. Collateral ligament injuries tend to to occur in basketball and volleyball players.
Metacarpal Neck Fractures (02:55)
Skier's thumb is a hyperextension of the ulnar collateral ligament; obtain an x-ray. Ensure there is no angular or rotational deformity in metacarpal neck fractures.
Credits: Examination of the Hand and Wrist (00:58)
Credits: Examination of the Hand and Wrist
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