REIDER PART 169
Chapter 4_Hand and Wrist 159
c
Figurę 4-93, cont'd.
TAKE HOME POINTS
When evaluating ulnar sided wrist pain:
1. Ulnar sided wrist pain has multiple causes and is not always a triangular fibrocartilage complex injury.
2. Since the distal radioulnar joint, triangular fibrocartilage complex, and lunotriquetral joint are only millimeters apart from each other, careful palpation is needed to determine precisely which is tender.
3. Triangular fibrocartilage complex tears and lunotriquetral joint injuries can occur after acute trauma or by degenerative changes, particularly in the presence of an ulnar impaction syndrome (impingement of the distal ulna on the carpus).
4. Trauma leads to fractures or ligament injuries at the wrist.
When evaluating radial sided wrist pain:
1. You must examine all of the radial sided wrist bones from the radius to the first metacarpal.
2. Performing the Finkelstein test by having the patient make a fist around their thumb will cause pain in many normal individuals. It should be performed as shown in Figurę 4-87.
3. Basilar joint instability often appears as thenar muscle pain (writer's cramps).
4. Basilar joint arthritis occurs in 18% of women over 50 years of age and 5% of men.
■ BIBLIOGRAPHY
Backdahl MJ: The caput ulnae syndrome in rheumatoid arthritis. Acta Rheumatol Scand. 1963; 5(suppl):l-75.
Burkhart SS, Wood MB, Linscheid RL: Posttraumatic recurrent sublux-ation of the extensor carpi ulnaris tendon. I Hand Surg (Am]. 1982; 7:1-3.
Burton RI: Basal joint arthrosis of the thumb. Orthop Glin North Am. 1973;4:347-348.
Coleman HM: Injuries of the articular disk at the wrist. J Bonę Joint Surg Br. 1960; 42:522-529.
Cooney WP: Tears of the triangular fibrocartilage of the wrist. In Cooney WP, Linscheid RL, Dobyns JH, eds. The Wrist: Diagnosis and Operative Treatment. St. Louis, CV Mosby, 1998:710-742. Durkan JA: A new diagnostic test for carpal tunnel syndrome. J Bonę Joint Surg Am. 1991; 73:535-538.
Finkelstein H: Stenosing tenosynovitis at the radial styloid process. J Bonę Joint Surg. 1930; 30:509.
Flatt AE: Care of the arthritic hand. St. Louis, CV Mosby, 1982. Kleinman W: The ballottement test. American Society for Surgery of the Hand Correspondence Newsletter. 1985:51.
Lichtman DM, Schneider JR, Swafford AR, Mack GR: Ulnar midcarpal instability—clinical and laboratory analysis. J Hand Surg |Am|. 1981;6:515-523.
Palmer AK: The distal radioulnar joint. Orthop Glin North Am. 1984; 15:321-335.
Phalen GS: Spontaneous compression of the median nerve at the wrist. JAMA. 1951; 145:1128-1133.
Phalen GS: The carpal-tunnel syndrome. Seventeen years’ experience in the diagnosis and treatment of six hundred fifty-four hands. J Bonę Joint Surg Am. 1966; 48:211-228.
Stewart JD, Eisen A: TineTs sign and the carpal tunnel syndrome. BMJ. 1978; 2:1125-1126.
Vaughan-Jackson OJ: Rupture of the extensor tendons by attrition at the interior radio-ulnar joint; report of two cases. J Bonę Joint Surg Br. 1948; 30:528-530.
Vaughan-Jackson OJ: Attrition ruptures of tendons in the rheumatoid hand. J Bonę Joint Surg Am. 1958; 40:1431.
Watson HK, Ashmead D IV, Makhlouf MV: Examination of the scaphoid. J Hand Surg [Am]. 1988; 13:657-660.
Watson HK, Weinzweig J: Physical examination of the wrist. Hand Glin. 1997; 13:17-34.
Wenger DR: Avulsion of the profundus tendon insertion in football players. Arch Surg. 1973; 106:145-149.
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