Download presentation
Presentation is loading. Please wait.
Published byMeagan Harper Modified over 8 years ago
1
James Pegrum (Peggers) MB BS BSc MSc MRCS Diploma (IKAR,IUAA,ISMM)
2
Overview Hand Anatomy Hand Examination Wrist & Arm X Rays
3
Hand Anatomy
4
Hand Anatomy – carpal bones “Some Loves Try Positions That They Can’t Handle”
5
Hand Anatomy – Carpal Tunnel Draw the carpal tunnel incision on each other
6
Hand Examination Overview Look Systemically Look Locally Feel Move Special Tests Function
7
look Systemically
8
Look Locally Finger Nails Clubbing Pitting Onycholysis Dorsum Guttering Bruising Scars Palmar Dupytrens Thenar wasting Scars Joints Heberdens nodes DIP Bourchard’s nodes PIP Deformity
9
Look Locally
10
Look
13
OA vs RA OARA SkinNMay be thin bruised – steriods Erythema Soft tissuesWasting of musclesMuscle wasating Synovitis around joints Warm & Tender BoneDIPJBilateral diffuse PIPJ DefomitySquaring of the palm Joint subluxation DIPJ Ulnar deviation fingers Radial deviation wrist Z deformity of thumb Swan neck & boutonierre
14
Look – Nails
15
Look
16
Peggers Top Tip A Rheumatoid patient what you need to tell the examiner……… Active or inactive disease? How do you tell? If the patient is rheumatoid factor positive? How do you tell?
17
Look
19
Peggers Top Tip When looking for a tendon injury place elbows on table/knee wrists flexed and finger pointing to each other………. Simple ask patient to extend the wrist and watch for the cascade
20
Look
22
Feel Tenderness Temperture Swelling Bogginess
23
Move Finger cascade Precision Grip Fist and note strength Supination / Pronation
24
Special Tests Carpal Tunnel De Quervain’s Flexor Tendons Neurological
25
Carpal Tunnel Tinels’ Tap Test Phalens Test
26
De Quervain’s Tests for tenosynovitis / Tendinopathy
27
Flexor Tendons FDP FDS
28
Neurological – Median Nerve Look Thenar muscle wasting Carpal tunnel scar Wrist laceration from self harm Feel Radial 3 ½ fingers Test “O Sign” thumb and Index finger
29
Neurological – Ulnar Nerve Look Hypothenar muscle wasting Wrist and elbow scars Feel Ulnar 1 ½ fingers Test Abduct and adduct fingers
30
Neurological – Radial Nerve Look Wrist drop Scars around humerus Feel Dorsal 1 st web space Test Wrist extension – “stop sign” Thumbs up
31
Functions – Day to day living Hold pen and write Keys Buttons on Shirts Stand from sitting
32
Summary Systemic Features Face Look Nails, Dorsum, Palmar, Joints Feel Tenderness, Swelling, Temperature, Bogginess Move Finger cascade, Precision, Fist, Supination/Pronation Special Tests Carpal tunnel, De Quervain’s, Flexors, Neurological Functions Pen, Keys, Buttons, Standing
33
X - Rays
34
Common Fractures
36
What you have learnt Hand Anatomy Hand Examination Common X Rays
37
Thank you This lecture and teaching materials can be found on the following website www. peggers super summaries. com (all 1 word) www.peggerssupersummaries.com
Similar presentations
© 2024 SlidePlayer.com. Inc.
All rights reserved.