Peggers Super Summaries: Hand Pathology and Examination
Hand pathology and examination
Arthritis:
STT
 Scaphotrapezotrapezoid OA
 Pain over scaphoid tubercle
CMC
 Dorsal and radial to STT pain
 CMC subluxes – Z shaped thumb
 Axial compression and thumb grind test exacerbates this – must hold wrist still for this
SNAC
 Scaphoid non-union advanced collapse
 Stages
o 1 – arthritis to radial styloid and scaphoid – fix scaphoid and excise styloid
o 2 - + scaphocapitate OA – 4 corner fusion or Viegus
o 3 - + lunate arthritis – 4 corner or wrist arthrodesis
SLAC
 Scapholunate advanced collapse
 Scaphoid flexes and lunate moves with intact ligament therefore DISI wrist picture
 Stages
o 1 – radioscaphoid OA with DISI – fuse STT + excise radial styloid
o 2 A – entire radioscaphoid OA
o 2 B - +STT OA – scaphoid excision + limited fusion
o 3 – radius/scaphoid/capitate/lunate OA – 4 corner or wrist fusion
DRUJ OA
 ECU can sublux in supination
 Dimple sign with piano key instability
 Supination pronation pain
Instability
DISSOCIATIVE
 Moves away from lunate – lunate moves with intact ligament
 Types
o SLL – lunate extends – DISI >70 degrees
 X-Ray – shows humpback deformity / Cortical ring sing
 MRI – High sensitivity medium specificity
 Arthroscopy gold standard
o LTL – lunate flexes with scaphoid – VISI < 30 degrees
CIND – carpal instability non-dissociative
 Occurs between rows of carpals ie midcarpal instability
CIC – carpal instability complex
Peggers Super Summaries: Hand Pathology and Examination

Combined Dissociative and CIND
Nerves
DIFFERENTIALS
 Tendon injury
 Tendon subluxation
 Joint dislocation or subluxation
MEDIAN
 Compression sites – Bicipital aponeurosis / PT pronator syndrome (no nocturnal
symptoms ) / FDS
 Sign – thenar wasting
 Special tests – FPL/FDP “OK sign” / flexion of wrist with elbows extended / Durkins
sign of thumb compression just proximal to carpal tunnel
ULNAR
 Compression sites – Arcade of struthers / medial intermuscular septum / cubital tunnel /
FCU / Guyons canal
 Sign – finger clawing (worse if distal as absent of flexors of the wrist) / 2rapeziec sign
little finger abduction
 Special – Froments sign, Tinels test
RADIAL
 Compression – Intermuscular septum / PIN – supinator muscle (through the radial tunnel)
/ watenburg’s syndrome – superficial radial nerve compression between brachioradialis
and ECRL
 Signs – wrist drop or dorsal sensory deficit
 Special – forceful forearm pronation
Tendons
DEQUERVAIN’S
 1st dorsal compartment tenosynovitis APL / EPB
 Finkelsteins
ECU SUBLUXATION
 6th dorsal tendon subluxation
 Goes volarly in supination and extension
TRIGGER FINGERS
 Tenosynovitis of flexor tendon
 Snapping finger at A1 pulley
INTERSECTION SYNDROME
 Between 1st and 2nd compartment
 Pain 5cm proximal to wrist crease exacerbated by resisted thumb and wrist extension
Peggers Super Summaries: Hand Pathology and Examination
DROPPED FINGER DD
 Tendon rupture / subluxation
 Nerve injury
 Joint dislocation or subluxation
ACCESSORY FINGER EXTENSION
 Extensor indices proprius and extensor digiti minimi (both ulnar to EDC)
 Rock on sign
INTRINSIC TIGHTNESS
 Bunnel Littler Test
 Tight in MCP extension try and flex PIPJ
 IF PIPJ still tight in MCP flexion then this is capsular tightness