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SUMMARY OF WRIST AND HAND DIAGNOSTIC CRITERIA AND PT MANAGEMENT STRATEGIES

IMPAIRMENT PATTERN HISTORY PHYSICAL EXAM PT MANAGEMENT


Wrist Mobility Deficits Trauma (e.g., fall onto outstretched hand ROM deficits (ext/flex/sup/pron) Soft Tissue Mobilization (STM) and
s/p Colles’ fracture with wrist extended) Pain at end of range of limited ROM Joint mobilization
s/p Fracture of scaphoid Stiff following immobilization Hypomobile radiocarpal, ulnomensico- Ther Ex’s (Gentle, prolonged PROM &
“Wrist capsulitis” Pain w/ end range flexion, extension, triquetral, distal radioulnar, and/or AROM stretching)
supination, and/or pronation movements intercarpal accessory movement tests
Hand Mobility Deficits Trauma – (e.g., forceful finger flexion Effusion or pain If acute, taping/bracing/splinting and
s/p Open wound of hand/finger while the finger is extending) Unable to voluntary move isolated joint hand surgery consult
with tendon involvement If post-op, bracing/splinting to protect
Tendon laceration or rupture healed tissue
If stiffness/mobility deficits: active &
passive ex’s per surgical protocol
Finger Mobility Deficits Trauma or repetitive hand use ROM deficits (extension/flexion) STM, Joint mobilization
Osteoarthrosis of the hand Finger pain – worse at end range of one Pain at end of range of limited ROM Ther Ex’s (Gentle, prolonged PROM &
s/p Fracture of metacarpal motion more than others Hypomobile IP and/or MP accessory tests AROM stretching)
s/p Fracture of phalanx/phalanges Effusion or pain
“Finger Capsulitis”
Hand Muscle Power Deficits Radial styloid area pain Symptoms reproduced with: Reduce aggravating factors
Radial styloid tenosynovitis Onset associated w/repetitive thumb and Resisted APL and EPB tests (pain & wkness) Ergomonic analysis/education
“de Quervain’s Syndrome” wrist movements or trauma to the area Stretch to APL/EPB tendons (Finklestein’s) Thumb/wrist tape/brace/splint
(e.g., blow to lateral wrist) Palpation/provocation of the APL and EPB Physical agents (Ice, Pulsed US, Ionto)
tendons Friction massage
Wrist & Hand Movement Trauma (e.g., fall onto wrist/hand) Effusion if acute. Stiffness if longstanding If acute: P.R.I.C.E., and/or Physical
Coordination Deficits Wrist pain – worse at end range of one End range pain with particular motion agents (E.Stim., US), Bracing
s/p Carpal sprains motion more than others Restricted accessory movements of distal If stiffness/mobility deficits: Joint
s/p Radiocarpal sprains radioulnar, ulnomeniscotriquetral, mobilization and Ther Ex’s
“Wrist Sprain” radiocarpal, or intercarpal articulations Taping/Bracing/Splinting
Wrist & Hand Movement Force abduction or adduction of finger Effusion P.R.I.C.E. instructions
Coordination Deficits – or –repetitive microtrauma Symptoms reproduced with: Taping/Bracing/Splinting
s/p PIP sprain / “Finger Sprain” Force abduction of thumb – or – 1st MP or 1st to 5th PIP varus/valgus stress test Later – PROM/AROM Ex’s
s/p MCP sprain / “Thumb Sprain” repetitive microtrauma Provocation of MP or PIP collateral ligaments
Hand Sensory Deficits Paresthesia and numbness in Median nerve Thenar atrophy, weakness Reduce aggravating factors
Carpal Tunnel Syndrome distribution – weakness develops later Sensory deficits to thumb/index finger Ergonomic analysis/education
(loss of grip strength) Symptoms reproduced with: Wrist bracing/splinting
Wrist/hand pain – often worse at night Median nerve bias ULTT Physical agents (US, Ionto)
Onset associated w/repetitive hand use, Provocation of carpal tunnel (inc. Phalen’s, Reduce entrapment
vibration, or sustained postures Tinel’s, and carpal compression test) (STM, Joint mob, Passive and active
Hand Sensory Deficits Paresthesia, numbness, and pain over ulnar Hand intrinsic atrophy mobilization for median nerve
Guyon’s syndrome aspect of palm and 5th digit intrinsic Sensory deficits in little finger (CTS) or ulnar nerve (GS)
weakness develops later Symptoms reproduced with:
Onset associated w/repetitive hand use or Ulnar nerve bias ULTT
sustained pressure over medial palm Provocation of Guyon’s Tunnel

Cuong Pho DPT, Joe Godges DPT KPSoCal Ortho PT Residency