So let's look at a case of wrist pain.
This is a 42-year-old woman journalist who's
presenting with tingling and pain of her wrists.
The symptoms have gradually
worsened over the last several years.
This pain and tingling are worse with
activity, and they often wake her up at night.
So there's a lot of different potential
causes of wrist and hand pain.
And it's going to be really important
for us to know our anatomy first.
First off, remember that the causes of wrist
and hand pain, like any musculoskeletal joint,
can be caused by either acute issues, for example,
traumatic if you fall out onto an outstretched hand
or more chronic overuse type injuries.
Here's a quick reminder of the
nomenclature for the different joints,
the DIPs, the PIPs, the MCPS and then
your carpal, metacarpal joints more proximally.
This slide highlights the specific
bones that make up the hand.
Remember that there are ligaments that
are connecting all these bones together
as well as with the
And a lot of them are particularly prone
to fracture or even avascular necrosis,
particularly the scaphoid and the lunate bone.
When we think about the
different types of manifestations,
of different types of disease processes
that can manifest with hand pain,
osteoarthritis is perhaps
the most common one.
And we'll talk about the distribution
of findings and the different joints
when we do the exam.
Carpal tunnel syndrome, a very common cause of
wrist and particularly thumb and first finger pain.
And you can see the carpal tunnel
illustrated there, this very tight compartment
through which a lot of
structures pass through.
and then De Quervain's tenosynovitis,
particularly in folks who do a lot of video gaming,
or even if you're carrying an
infant for a prolonged period of time,
you can end up with having issues
with the extensor tendons on the thumb.
So we'll need to consider all those
potential disease processes as we move on
to identify which process is happening
in our patient, and that's going to require
a thorough and competent physical exam.