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Wrist Pain: Pramono Ari Wibowo, MD
Wrist Pain: Pramono Ari Wibowo, MD
Wrist Pain: Pramono Ari Wibowo, MD
HAND DIVISION
R U
RADIAL SIDED PAIN
• Physical exam :
• Swelling over dorsal aspect of the wrist
• Tenderness over the dorsal Scapholunate interval or Anatomical snuffbox
• Motion : pain increased with extreme wrist extension and radial deviation
• Symptoms :
• Numbness and tingling in radial 3-1/2 digits
• Pain and paresthesia that awaken patient at night
• Physical exam :
• May show thenar atrophy
• Durkan’s test
• Phalen test
• Tinel’s test
CARPAL TUNNEL SYNDROME (CTS)
• TFCC tear
• DRUJ disruption
• ECU tendinitis
• Ulnar tunnel syndrome
• Hook of hamate fracture
• Luno-triquetrum dissociation
TRIANGULAR FIBROCARTILAGE COMPLEX (TFCC)
• Treatment :
• Non operative
• Local decompression
• Tendon transfer
• Carpal tunnel release
HOOK OF HAMATE
FRACTURE
• Incidence 2% of carpal fracture
• Risk factor : golf, baseball, hockey
• Symptoms : Hypothenar pain
• Physical exam : Hook of hamate pull test
• Neurovascula exam
• Imaging : X-ray, CT-scan
• Treatment :
• Non operative
• Excision hamate
• Common pain source in ulnar side of the wrist
• Diagnosis may challenging because ECU is aposed
closely to other structure including TFCC
• When examining the ECU, it’s important to differentiate
EXTENSOR
between ECU tendinitis and pain secondary to
CARPI ULNARIS subluxation
TENDINITIS
• Pain is localized over the ulnar side of the wrist and
worsen with gripping and other heavy activities. But
usually the patient may be unable to localize the site of
the pain easily
• ECU tendinitis is often seen in non athletes.
EXTENSOR CARPI ULNARIS
TENDINITIS
• ROM may not be restricted, but resisted ulnar deviation when
the forearm is pronation OR resisted wrist extension when
the forearm is supinated.
• Rolling the tendon under the examiner’s finger may elicit
crepitus
• The ECU synergy test is helpful in differentiating between
ECU pathology and intra-articular.
• Patients are assessed for subluxation of ECU tendon
• The examiner moves the patient’s wrist from a supination and
extension to flexion and ulnar devviation
• Plain radiographs PA grip view to evaluate
ulnar positive. Also ulnar impaction as an
alternative source of pain
EXTENSOR CARPI
ULNARIS TENDINITIS • USG or MRI may be used to confirm
- DIAGNOSIS tendinopathy, or other pathology
• Diagnostic criteria can be improved by
injecting local anesthethis into ECU sheath
• Conservative :
• Rest
EXTENSOR CARPI • Activity modification
ULNARIS TENDINITIS • Physical therapy
- MANAGEMENT • NSAID or steroid injection
• Surgical :
• Remove fibro-osseus structure
• Creating a pulley in subluxation case
THANK YOU