Patient Introduction and Review of Hand Anatomy

by Stephen Holt, MD, MS

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      Slides Physical Exam Wrist Pain Introduction.pdf
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      Reference List Physical Examination.pdf
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    00:00 So let's look at a case of wrist pain.

    00:03 This is a 42-year-old woman journalist who's presenting with tingling and pain of her wrists.

    00:09 The symptoms have gradually worsened over the last several years.

    00:12 This pain and tingling are worse with activity, and they often wake her up at night.

    00:17 So there's a lot of different potential causes of wrist and hand pain.

    00:21 And it's going to be really important for us to know our anatomy first.

    00:25 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.

    00:39 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.

    00:50 This slide highlights the specific bones that make up the hand.

    00:53 Remember that there are ligaments that are connecting all these bones together as well as with the metacarpophalangeal joints.

    01:00 And a lot of them are particularly prone to fracture or even avascular necrosis, particularly the scaphoid and the lunate bone.

    01:07 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.

    01:16 And we'll talk about the distribution of findings and the different joints when we do the exam.

    01:21 Carpal tunnel syndrome, a very common cause of wrist and particularly thumb and first finger pain.

    01:28 And you can see the carpal tunnel illustrated there, this very tight compartment through which a lot of structures pass through.

    01:34 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.

    01:47 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.

    About the Lecture

    The lecture Patient Introduction and Review of Hand Anatomy by Stephen Holt, MD, MS is from the course Examination of the Upper Extremities.

    Included Quiz Questions

    1. De Quervain's tenosynovitis
    2. Carpal tunnel syndrome
    3. Osteoarthritis of the distal interphalangeal joint of the hand
    4. Avascular necrosis of the scaphoid
    5. Lateral epicondylitis

    Author of lecture Patient Introduction and Review of Hand Anatomy

     Stephen Holt, MD, MS

    Stephen Holt, MD, MS

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