Musculoskeletal problems of the wrist and hand history and symptoms: Difference between revisions
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=== Painful Movement === | === Painful Movement === | ||
* '''Dorsal Wrist Pain''' | * '''Dorsal Wrist Pain''' | ||
* | ** Most common complaint | ||
* | ** Traumatic injury | ||
* | *** Distal radial fracture | ||
* | **** After fall on outstretched arm (Colles’ fracture) | ||
* | **** Common in young & in elderly with [[osteoporosis]] | ||
* | *** [[Scaphoid]] fracture | ||
* | **** Most common bony injury | ||
* | **** Tenderness in anatomic snuff box | ||
* | **** Need scaphoid view +/- follow up films at 2 weeks to detect | ||
* | **** Poor blood supply--risk nonunion, [[avascular necrosis]] | ||
* | *** Perilunate dislocation | ||
* | **** After fall on outstretched, extended wrist | ||
* | **** Dorsal shift of all bones due to severe ligament injury | ||
* | **** Only lunate remains articulated with radius | ||
* | **** X-ray with increased interosseous scaphoid-lunate distance | ||
* | *** Simple [[sprain]] | ||
* | **** Injury to supporting ligaments of radiocarpal joint | ||
* | *** Mild pain or stiffness | ||
* | *** Normal range of motion (ROM) or <10% loss of flexion/extension | ||
* | *** Resolves within 2 weeks with conservative therapy | ||
* | ** Atraumatic | ||
* | *** Radiocarpal [[arthritis]] | ||
* | **** Unilateral usually due to prior trauma--secondary [[osteoarthritis]] (OA) | ||
* | **** Uncommon site for primary OA | ||
* | **** Bilateral arthritis likely due to RA or crystals | ||
* | **** Wrist more common site for pseudogout than [[gout]] | ||
* | **** Septic arthritis of wrist rare | ||
* | **** Pain, swelling and reduced ROM of wrist | ||
* '''Radial Wrist Pain and Grip Weakness''' | * '''Radial Wrist Pain and Grip Weakness''' | ||
* | ** DeQuervain’s Tenosynovitis | ||
* | *** Abductor pollicis longus and extensor pollicis (snuffbox) tendons | ||
* | *** Pain worst over distal radial styloid | ||
* | *** Pain worsened by activity, relieved by rest; history wrist/hand overuse | ||
* | ** CMC Arthritis | ||
* | *** Common, due to repetitive gripping/grasping or vibration exposure | ||
* | *** Wear and tear of [[articular cartilage]] at base of thumb | ||
* | *** Pain and swelling at base of thumb | ||
* | ** Gamekeeper’s thumb | ||
* | *** Disruption of the ulnar collateral ligament of the MP joint | ||
* | *** Due to trauma (ski pole injuries) or repetitive use | ||
* | *** Instability of metacarpal (MP) joint, loss of pinch/opposition function/strength | ||
* | *** Pain and swelling on ulnar side of MP joint | ||
* | *** Late degenerative arthritic change | ||
* | ** [[Osteonecrosis]] | ||
* | *** Usually involves scaphoid and lunate, history trauma in 50% | ||
* | *** Reduced wrist flexion/extension, decreased grip strength | ||
* | *** Most severe tenderness over anatomical snuff box | ||
* | *** Can take 4-8 weeks for X-rays to show lesion; bone scan shows earlier | ||
=== Dorsal Swelling === | === Dorsal Swelling === | ||
* '''Localized''' | * '''Localized''' | ||
* | ** [[Ganglion cyst]] | ||
* | *** Painless abnormal accumulation of synovial or tenosynovial fluid | ||
* | *** Due to subtle abnormalities in wrist or extensor tendon sheath | ||
* | *** Overproduction of fluid irritates scar tissue and causes cyst formation | ||
* | *** Small % of patients have pain due to cyst pressure on tendons/radial nerve | ||
* | *** +/- [[Paresthesia]]s over back of hand/fingers (pressure on superficial radial nerve) | ||
* '''Diffuse''' | * '''Diffuse''' | ||
* | ** Extensor tenosynovitis | ||
* | *** Swelling from wrist to back of hand | ||
* | *** Pain aggravated by movement of fingers | ||
=== Stiffness === | === Stiffness === | ||
* '''[[Rheumatoid Arthritis]] (RA)''' | * '''[[Rheumatoid Arthritis]] (RA)''' | ||
* | ** Symmetrical joint symptoms with morning stiffness | ||
* '''[[Carpal Tunnel Syndrome]] (CTS)''' | * '''[[Carpal Tunnel Syndrome]] (CTS)''' | ||
* | ** Can have stiffness as prominent feature | ||
=== Sensory Changes with Wrist Use === | === Sensory Changes with Wrist Use === | ||
* '''[[Carpal Tunnel Syndrome]]''' | * '''[[Carpal Tunnel Syndrome]]''' | ||
* | ** Compression [[neuropathy]] of the median nerve at the carpal ligament | ||
* | ** Loss of sensation at the tips of the first 3 fingers | ||
* | ** Grip [[weakness]], pain at wrist +/- radiation to fingers or forearm | ||
* | ** Pain may awaken patient at night; may be relieved with wrist motion | ||
* | ** Usually idiopathic | ||
* | ** Can be due to reduced space in tunnel | ||
* | *** [[Tenosynovitis]] / inflammatory [[arthritis]] | ||
* | *** [[Acromegaly]] | ||
* | *** [[Pregnancy]] (3rd trimester) | ||
* | *** [[Hypothyroidism]] | ||
* | *** [[Chronic renal failure]] | ||
* | *** [[Amyloidosis]] | ||
* | ** Can be due to increased susceptibility to pressure | ||
* | *** [[Diabetes mellitus]] (DM) | ||
* | *** [[Vasculitis]] | ||
* | *** Hereditary [[neuropathy]] | ||
== References == | == References == | ||
{{Reflist}} | {{Reflist}} | ||
Line 98: | Line 98: | ||
[[Category:Disease]] | [[Category:Disease]] | ||
[[Category:Musculoskeletal Disease]] | [[Category:Musculoskeletal Disease]] | ||
[[Category:Needs overview]] | [[Category:Needs overview]] |
Latest revision as of 22:49, 29 July 2020
Musculoskeletal problems of the wrist and hand Microchapters |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
History and Symptoms
Painful Movement
- Dorsal Wrist Pain
- Most common complaint
- Traumatic injury
- Distal radial fracture
- After fall on outstretched arm (Colles’ fracture)
- Common in young & in elderly with osteoporosis
- Scaphoid fracture
- Most common bony injury
- Tenderness in anatomic snuff box
- Need scaphoid view +/- follow up films at 2 weeks to detect
- Poor blood supply--risk nonunion, avascular necrosis
- Perilunate dislocation
- After fall on outstretched, extended wrist
- Dorsal shift of all bones due to severe ligament injury
- Only lunate remains articulated with radius
- X-ray with increased interosseous scaphoid-lunate distance
- Simple sprain
- Injury to supporting ligaments of radiocarpal joint
- Mild pain or stiffness
- Normal range of motion (ROM) or <10% loss of flexion/extension
- Resolves within 2 weeks with conservative therapy
- Distal radial fracture
- Atraumatic
- Radiocarpal arthritis
- Unilateral usually due to prior trauma--secondary osteoarthritis (OA)
- Uncommon site for primary OA
- Bilateral arthritis likely due to RA or crystals
- Wrist more common site for pseudogout than gout
- Septic arthritis of wrist rare
- Pain, swelling and reduced ROM of wrist
- Radiocarpal arthritis
- Radial Wrist Pain and Grip Weakness
- DeQuervain’s Tenosynovitis
- Abductor pollicis longus and extensor pollicis (snuffbox) tendons
- Pain worst over distal radial styloid
- Pain worsened by activity, relieved by rest; history wrist/hand overuse
- CMC Arthritis
- Common, due to repetitive gripping/grasping or vibration exposure
- Wear and tear of articular cartilage at base of thumb
- Pain and swelling at base of thumb
- Gamekeeper’s thumb
- Disruption of the ulnar collateral ligament of the MP joint
- Due to trauma (ski pole injuries) or repetitive use
- Instability of metacarpal (MP) joint, loss of pinch/opposition function/strength
- Pain and swelling on ulnar side of MP joint
- Late degenerative arthritic change
- Osteonecrosis
- Usually involves scaphoid and lunate, history trauma in 50%
- Reduced wrist flexion/extension, decreased grip strength
- Most severe tenderness over anatomical snuff box
- Can take 4-8 weeks for X-rays to show lesion; bone scan shows earlier
- DeQuervain’s Tenosynovitis
Dorsal Swelling
- Localized
- Ganglion cyst
- Painless abnormal accumulation of synovial or tenosynovial fluid
- Due to subtle abnormalities in wrist or extensor tendon sheath
- Overproduction of fluid irritates scar tissue and causes cyst formation
- Small % of patients have pain due to cyst pressure on tendons/radial nerve
- +/- Paresthesias over back of hand/fingers (pressure on superficial radial nerve)
- Ganglion cyst
- Diffuse
- Extensor tenosynovitis
- Swelling from wrist to back of hand
- Pain aggravated by movement of fingers
- Extensor tenosynovitis
Stiffness
- Rheumatoid Arthritis (RA)
- Symmetrical joint symptoms with morning stiffness
- Carpal Tunnel Syndrome (CTS)
- Can have stiffness as prominent feature
Sensory Changes with Wrist Use
- Carpal Tunnel Syndrome
- Compression neuropathy of the median nerve at the carpal ligament
- Loss of sensation at the tips of the first 3 fingers
- Grip weakness, pain at wrist +/- radiation to fingers or forearm
- Pain may awaken patient at night; may be relieved with wrist motion
- Usually idiopathic
- Can be due to reduced space in tunnel
- Tenosynovitis / inflammatory arthritis
- Acromegaly
- Pregnancy (3rd trimester)
- Hypothyroidism
- Chronic renal failure
- Amyloidosis
- Can be due to increased susceptibility to pressure
- Diabetes mellitus (DM)
- Vasculitis
- Hereditary neuropathy