REIDER PART 1
36

126 Chapter.4 Hand and Wrist

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1 4-2 • W hen a patient complains of pain on the ulnar side of the wrist

If There is a History of Trauma:

Wrist swelling and pain dorsally:

•    Subluxing extensor carpi ulnaris (ECU)

•    Triangular fibro cartilage complex (TFCC) Injury

•    Avulsion fracture of the triquetrum

•    Lunotriquetral (LT) ligament tear

Wrist swelling and pain volarly:

•    Pisiform fracture

•    Hook of the hamate fracture

If There is No History of Trauma:

•    Extensor carpi ulnaris (ECU) tendonitis

•    TFCC degenerative tear

•    Lunotriquetral degenerative tear

•    Ulnar impaction syndrome

•    Distal radioulnar joint (DRUJ) arthritis

•    Pisotriquetral arthritis

Relevant Physical Exam:

General:

•    Look for location of swelling

•    Palpate for edema or synovitis

•    Look for deformity

Subluxing ECU:

•    Palpate ulnar grove for tendon

•    Test for instability (see Fig. 4-50)

TFCC tear:

•    Tenderness just distal to the ulnar head

•    Pain with ulnar deviation

•    Popping or crepitus with ulnar deviation

•    Positive piano key sign—instability of the DRUJ

Triouetral avulsion fracture:

•    Tenderness and swelling over the triquetrum

Lunotriquetral ligament tear:

•    Tenderness at the LT joint

•    Abnormal shuck test

Pisiform fracture:

•    Tenderness to direct palpation of pisiform Hook of hamate fracture:

•    Tenderness to direct palpation over the hook of the Hamate

ECU tendonitis:

•    Swelling over the ECU

•    Pain with ulnar deviation of the wrist against resist-ance

Degenerative TFCC Tear:

•    Tenderness just distal to the ulnar head

•    Pain with ulnar deviation

•    Popping with ulnar deviation and axial compression Degenerative lunotriquetral ligament tear:

•    Tenderness at the LT joint

•    Positive shuck test

Ulnar impaction syndrome:

•    Pain with ulnar deviation and axial compression

•    Popping with ulnar deviation and axial compression

Druj arthritis

•    Pain with supination/pronation, particularly with squeezing the joint

PlSOTRIQUETRAL ARTHRITIS:

•    Pain when compressing the pisiform against the tri-quetrum and flexing/extending the wrist

•    Pain and crepitus with ulnar/radial deviation of the pisiform against the triguetrum

Figurę 4-38. A, Acthre finger flexion. B, Active flexion of ihc intcrphalangeal joints only.