[Script Info]
Title: 
[Events]
Format: Layer, Start, End, Style, Name, MarginL, MarginR, MarginV, Effect, Text
Dialogue: 0,0:00:00.00,0:00:02.67,Default,,0000,0000,0000,,(English captions by Jade Cheng from the University of Michigan)
Dialogue: 0,0:00:02.67,0:00:06.63,Default,,0000,0000,0000,,In performing the musculoskeletal exam of\Nthe wrist and hand, it is prudent to develop
Dialogue: 0,0:00:06.63,0:00:08.43,Default,,0000,0000,0000,,a systematic approach.
Dialogue: 0,0:00:08.43,0:00:12.33,Default,,0000,0000,0000,,The following is a suggested order of exam\Nthat incorporates the common techniques for
Dialogue: 0,0:00:12.33,0:00:15.38,Default,,0000,0000,0000,,diagnosing musculoskeletal wrist and hand\Ninjuries.
Dialogue: 0,0:00:15.38,0:00:17.95,Default,,0000,0000,0000,,The wrist and hand exam begins with inspection.
Dialogue: 0,0:00:17.95,0:00:23.71,Default,,0000,0000,0000,,With the arm supinated, assess for asymmetry,\Nthenar and hypothenar muscular atrophy, or
Dialogue: 0,0:00:23.71,0:00:26.14,Default,,0000,0000,0000,,skin changes.
Dialogue: 0,0:00:26.14,0:00:30.85,Default,,0000,0000,0000,,Observe for evidence of finger malrotation,\Nwhich can be seen with displacement carpal
Dialogue: 0,0:00:30.85,0:00:34.09,Default,,0000,0000,0000,,fractures.
Dialogue: 0,0:00:34.09,0:00:40.51,Default,,0000,0000,0000,,With the hand pronated, assess for asymmetry,\Nmuscular atrophy, or skin changes.
Dialogue: 0,0:00:40.51,0:00:42.58,Default,,0000,0000,0000,,Next evaluate active range of motion.
Dialogue: 0,0:00:42.58,0:00:47.35,Default,,0000,0000,0000,,If pain or limitation exists, repeat the range\Nof motion passively.
Dialogue: 0,0:00:47.35,0:00:54.35,Default,,0000,0000,0000,,Check for wrist flexion; extension; radial\Ndeviation; ulnar deviation; thumb extension;
Dialogue: 0,0:01:00.01,0:01:07.01,Default,,0000,0000,0000,,thumb flexion; thumb abduction and adduction;\Nthumb opposition; digit flexion and extension
Dialogue: 0,0:01:13.34,0:01:20.34,Default,,0000,0000,0000,,at the MCP, the PIP, and DIP joints; and digit\Nabduction and adduction.
Dialogue: 0,0:01:25.69,0:01:32.69,Default,,0000,0000,0000,,Next check resisted strength: wrist flexion;\Nresisted wrist extension; resisted radial
Dialogue: 0,0:01:36.51,0:01:43.51,Default,,0000,0000,0000,,deviation and ulnar deviation; resisted thumb\Nextension, thumb flexion, thumb abduction,
Dialogue: 0,0:01:55.61,0:02:02.61,Default,,0000,0000,0000,,and adduction; resisted thumb opposition;\Nand resisted finger flexion at the MCP, extension
Dialogue: 0,0:02:12.92,0:02:19.92,Default,,0000,0000,0000,,at the MCP, flexion at the PIP, extension\Nat the PIP, flexion at the DIP, extension
Dialogue: 0,0:02:27.29,0:02:34.29,Default,,0000,0000,0000,,at the DIP; digit abduction and resisted adduction.
Dialogue: 0,0:02:39.19,0:02:46.19,Default,,0000,0000,0000,,Next palpate landmarks: the thenar eminence,\Nthe scaphoid tubercle, the hypothenar eminence,
Dialogue: 0,0:02:54.20,0:03:01.20,Default,,0000,0000,0000,,the pisiform, and the hamate.
Dialogue: 0,0:03:04.26,0:03:11.26,Default,,0000,0000,0000,,Palpate the radial styloid; Lister's tubercle;\Nthe anatomic snuff box; the scapholunate junction,
Dialogue: 0,0:03:18.24,0:03:25.24,Default,,0000,0000,0000,,just proximal to the third metacarpal base;\Nthe ulna styloid; the triangular fibrocartilage
Dialogue: 0,0:03:27.85,0:03:34.85,Default,,0000,0000,0000,,complex; along the metacarpals; and the fingers.
Dialogue: 0,0:03:43.45,0:03:47.61,Default,,0000,0000,0000,,Specific testing of the wrist and hand to\Nevaluate for musculoskeletal injuries may
Dialogue: 0,0:03:47.61,0:03:51.20,Default,,0000,0000,0000,,include, but is not limited to, the following\Ntests.
Dialogue: 0,0:03:51.20,0:03:57.00,Default,,0000,0000,0000,,There are several tests commonly performed\Nto evaluate for carpal tunnel syndrome.
Dialogue: 0,0:03:57.00,0:04:00.39,Default,,0000,0000,0000,,The carpal compression test evaluates for\Ncarpal tunnel syndrome.
Dialogue: 0,0:04:00.39,0:04:03.98,Default,,0000,0000,0000,,Provide direct compression over the carpal\Ntunnel on the lower side of the wrist for
Dialogue: 0,0:04:03.98,0:04:05.64,Default,,0000,0000,0000,,up to thirty seconds.
Dialogue: 0,0:04:05.64,0:04:09.41,Default,,0000,0000,0000,,Reproduction of pain, numbness, or tingling\Nis a positive test.
Dialogue: 0,0:04:09.41,0:04:11.78,Default,,0000,0000,0000,,Perform a Tinel's by tapping over the carpal\Ntunnel.
Dialogue: 0,0:04:11.78,0:04:15.55,Default,,0000,0000,0000,,Reproduction of pain, numbness, or tingling\Nis a positive test.
Dialogue: 0,0:04:15.55,0:04:18.75,Default,,0000,0000,0000,,Phalen's test evaluates for carpal tunnel\Nsyndrome.
Dialogue: 0,0:04:18.75,0:04:22.72,Default,,0000,0000,0000,,Fully flex wrists and adduct dorsal surfaces\Nof hands together.
Dialogue: 0,0:04:22.72,0:04:29.22,Default,,0000,0000,0000,,Reproduction of pain or tingling is a positive\Ntest.
Dialogue: 0,0:04:29.22,0:04:33.22,Default,,0000,0000,0000,,The ulnar compression evaluates for ulnar\Ntunnel syndrome.
Dialogue: 0,0:04:33.22,0:04:37.19,Default,,0000,0000,0000,,Provide direct pressure over the ulnar tunnel\Nor Guyon's canal deep to the hypothenar
Dialogue: 0,0:04:37.19,0:04:39.76,Default,,0000,0000,0000,,eminence for up to thirty seconds.
Dialogue: 0,0:04:39.76,0:04:42.20,Default,,0000,0000,0000,,Pain or numbness is a positive test.
Dialogue: 0,0:04:42.20,0:04:45.79,Default,,0000,0000,0000,,Next, perform a Tinel's by tapping over\Nthe ulnar tunnel.
Dialogue: 0,0:04:45.79,0:04:50.00,Default,,0000,0000,0000,,Reproduction of pain is a positive test.
Dialogue: 0,0:04:50.00,0:04:53.79,Default,,0000,0000,0000,,Patients with compromise of the ulnar nerve\Nwill not be able to cross the second and third
Dialogue: 0,0:04:53.79,0:04:58.93,Default,,0000,0000,0000,,fingers, or hold a piece of paper between\Ntheir first and second fingers against resistance,
Dialogue: 0,0:04:58.93,0:05:01.89,Default,,0000,0000,0000,,known as Frommet's sign.
Dialogue: 0,0:05:01.89,0:05:07.15,Default,,0000,0000,0000,,Patients with compromise of anterior interosseous\Nnerve will not be able to perform the OK sign.
Dialogue: 0,0:05:07.15,0:05:11.00,Default,,0000,0000,0000,,An abnormal test may look like this.
Dialogue: 0,0:05:11.00,0:05:15.12,Default,,0000,0000,0000,,There are two tests commonly performed to\Nevaluate scapholunate instability.
Dialogue: 0,0:05:15.12,0:05:18.41,Default,,0000,0000,0000,,The Shuck test assesses for scapholunate instability.
Dialogue: 0,0:05:18.41,0:05:22.41,Default,,0000,0000,0000,,With the wrist flexed, the examiner resists\Nfinger extension.
Dialogue: 0,0:05:22.41,0:05:26.74,Default,,0000,0000,0000,,Pain over the dorsum of the wrist is considered\Na positive test.
Dialogue: 0,0:05:26.74,0:05:31.08,Default,,0000,0000,0000,,Watson's test assesses for scapholunate\Ninstability.
Dialogue: 0,0:05:31.08,0:05:36.78,Default,,0000,0000,0000,,The examiner places a thumb over the patient's\Nscaphoid tubercle, applying dorsal pressure.
Dialogue: 0,0:05:36.78,0:05:40.93,Default,,0000,0000,0000,,The wrist is then moved from ulnar to radial\Ndeviation.
Dialogue: 0,0:05:40.93,0:05:45.65,Default,,0000,0000,0000,,A painful clunk is considered a positive test.
Dialogue: 0,0:05:45.65,0:05:50.62,Default,,0000,0000,0000,,Finkelstein's test evaluates for De Quervain's\Ntenosynovitis.
Dialogue: 0,0:05:50.62,0:05:54.55,Default,,0000,0000,0000,,The patient places the thumb in the palm,\Nwraps fingers around it, and the wrist is
Dialogue: 0,0:05:54.55,0:05:56.69,Default,,0000,0000,0000,,passively ulnar deviated.
Dialogue: 0,0:05:56.69,0:06:00.30,Default,,0000,0000,0000,,Reproduction of pain is a positive test.
Dialogue: 0,0:06:00.30,0:06:04.12,Default,,0000,0000,0000,,Testing for osteoarthritis of the thumb at\Nthe trapezium metacarpal joint is done by
Dialogue: 0,0:06:04.12,0:06:06.21,Default,,0000,0000,0000,,using the axial grind test.
Dialogue: 0,0:06:06.21,0:06:11.10,Default,,0000,0000,0000,,The examiner grasps the thumb and places an\Naxial force with grinding.
Dialogue: 0,0:06:11.10,0:06:15.12,Default,,0000,0000,0000,,Reproduction of pain is a positive test.
Dialogue: 0,0:06:15.12,0:06:19.05,Default,,0000,0000,0000,,Ulnar collateral ligament testing of the thumb\Nis performed to evaluate for instability found
Dialogue: 0,0:06:19.05,0:06:21.40,Default,,0000,0000,0000,,on a gamekeeper's or skier's thumb.
Dialogue: 0,0:06:21.40,0:06:26.87,Default,,0000,0000,0000,,After stabilizing the first metacarpal, a\Nvalgus stress is applied to the thumb at the
Dialogue: 0,0:06:26.87,0:06:28.27,Default,,0000,0000,0000,,metacarpophalangeal joint.
Dialogue: 0,0:06:28.27,0:06:33.49,Default,,0000,0000,0000,,Laxity indicates a partial or complete ulnar\Ncollateral ligament tear.
Dialogue: 0,0:06:33.49,0:06:38.28,Default,,0000,0000,0000,,Several tests can be performed to evaluate\Nfor finger pain.
Dialogue: 0,0:06:38.28,0:06:40.66,Default,,0000,0000,0000,,Evaluate the injured finger for flexion.
Dialogue: 0,0:06:40.66,0:06:45.43,Default,,0000,0000,0000,,Inability to flex the isolated finger at the\Nmetacarpophalangeal joint may indicate a partial
Dialogue: 0,0:06:45.43,0:06:52.24,Default,,0000,0000,0000,,or complete tear of the flexor digitorum superficialis.
Dialogue: 0,0:06:52.24,0:06:55.96,Default,,0000,0000,0000,,Isolate the distal interphalangeal joint over the\Nedge of the table and observe for flexion
Dialogue: 0,0:06:55.96,0:06:58.44,Default,,0000,0000,0000,,at this joint to perform the Boyes' test.
Dialogue: 0,0:06:58.44,0:07:03.03,Default,,0000,0000,0000,,Inability to flex at the DIP may indicate\Na partial or complete tear of the flexor digitorum
Dialogue: 0,0:07:03.03,0:07:06.19,Default,,0000,0000,0000,,profundus, also known as Jersey finger.
Dialogue: 0,0:07:06.19,0:07:10.81,Default,,0000,0000,0000,,Elson's test evaluates for partial or complete\Ntear of the extensor digitorum.
Dialogue: 0,0:07:10.81,0:07:15.00,Default,,0000,0000,0000,,Isolate the proximal interphalangeal joint\Nover the edge of the table and provide resistance
Dialogue: 0,0:07:15.00,0:07:16.49,Default,,0000,0000,0000,,against extension.
Dialogue: 0,0:07:16.49,0:07:21.20,Default,,0000,0000,0000,,Inability to extend at the PIP is a positive\Ntest.
Dialogue: 0,0:07:21.20,0:07:24.79,Default,,0000,0000,0000,,Ulnar collateral ligament stability can be\Ntested at zero and thirty degrees of flexion
Dialogue: 0,0:07:24.79,0:07:27.69,Default,,0000,0000,0000,,by applying a valgus force to the finger.
Dialogue: 0,0:07:27.69,0:07:31.87,Default,,0000,0000,0000,,Radial collateral ligament stability can also\Nbe tested at zero and thirty degrees of flexion
Dialogue: 0,0:07:31.87,0:07:34.40,Default,,0000,0000,0000,,by applying a varus force to the finger.
Dialogue: 0,0:07:34.40,0:07:37.97,Default,,0000,0000,0000,,Laxity indicates a partial or complete ligament\Ntear.
Dialogue: 0,0:07:37.97,0:07:41.74,Default,,0000,0000,0000,,In concluding the wrist exam it is important\Nto document a neurovascular exam.
Dialogue: 0,0:07:41.74,0:07:45.89,Default,,0000,0000,0000,,Here we check radial artery pulse and capillary\Nrefill testing.
Dialogue: 0,0:07:45.89,0:07:48.64,Default,,0000,0000,0000,,Further neurovascular exam may be indicated\Nby history.
Dialogue: 0,0:07:48.64,0:07:50.00,Default,,0000,0000,0000,,Acknowledgement: The Japanese translation of this video was made as part of Shizuoka-University of Michigan Advanced Residency Training, Education and Research in Family Medicine (SMARTER FM) Project supported by Shizuoka Prefecture and funded by the Community Healthcare Revival Fund.