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Hand pain 1

(Hand pain)
.

non-articular rheumatism

2

1. (
)
2.
(refer pain)

rheumatoid nodule,
gouty tophi ganglion



(avascular necrosis)
dermatome
median nerve, radial nerve
ulnar nerve C7, C8 T1
bracheal plexus, radial groove, ulnar groove carpal tunnel

Raynauds phenomenon gangrene

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Hand pain 2

thoracic outlet
( 1)
1

, MCP, PIP, DIP
, hypermobility,
( wrist, MCP, PIP joints)
(first carpometacarpal, PIP DIP joints)
: , , ,


: Rheumatoid nodules, gouty tophi, painful subcutaneous calcific nodules in scleroderma
Plamar fascia : Doupuytrens contracture
:
tenosynovitis de Quervains tenosynovitis extensor carpi
radialis tenosynovitis
tenosynovitis carpal tunnel syndrome
tenosynovitis : thumb flexor tendinitis (trigger thumb) finger flexor tendinitis
Pigmented villonodular tenosynovitis (giant cell tumor )
Acute calcific periarthritis (wrist, MCP, rarely PIP DIP)
Ganglion

, , , (lunate scaphoid)

Medain nerve
carpal tunnel syndrome (), pronator teres syndrome,
anterior interosseous nerve syndrome
Ulnar nerve
cubital tunnel syndrome (), Guyons canal ()
Posterior interosseous nerve syndrome
Radial nerve palsy (spinal groove syndrome)
Lower brachial plexus
thoracic outlet syndrome, Pancoasts tumor
Cervical nerve roots
Herniated cervical disc,

, syringomyelia

Vasospastic disorders : Raynauds phenomenon, scleroderma. occupational vibration syndrome,

Small and large vessel vasculitis SLE, RA Takayasus arteritis


Reflex sympathetic dystrophy syndrome shoulder hand syndrome causalgia
Cardiac : angina pectoris

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Hand pain 3

1.
1.1 , MCP, PIP
DIP

1.2
( 2)

2.


(carpometacarpal joint) anatomical
snuff box
squaring sign

( )

1. Tinels sign Phalens test carpal tunnel syndrome

median nerve ( palmaris longus
) (Tinels sign)
30-60 (Phalens test)
median nerve
Phalens test
2. Finkelsteins test De Quervain stenosing tenosynovitis
ulnar diviation
abductor policis longus extensor policis brevis

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Hand pain 4

3. Allens test radial

ulnar
radial ulnar
2

: volar subluxation, radial diviation, ulna

styloid (distal radioulnar joint subluxation)r
thenar area (median nerve )

ulnar styloid
ulnar styloid
hypertrophic osteoarthropathy
ganglion, rheumatoid nodule, gouty tophi,
Heburdens Buchards nodes

Raynauds phenomenon, vascular gangrene

SLE
dermatomyositis
psoriasis
PIP
tendinitis, dactylitis SNSA

(clubbing of fingers)

sclerodactyly, telangiectasia , digital pitting scars

nailfold infartion
periungual erythema

(fusiform swelling)
(sausage finger)
MCP : ulnar diviation, volar subluxation flexion
deformity
Boutonniere swan neck deforimty Z deformity
(flexion deformity MCP hyperextension IP)

(palmar aponurosis)

carpal tunnel syndrome

,
inflammatory arthritis
Dupruytrens contracture

MCP joints

, thoracic outlet,
4

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Hand pain 5

non-articular
rheumatism 2 stenosing digital tenosynovitis flexor
tendinitis de Quervain stenosing tenosynovitis De Quervain syndrome
Dupuytrens contracture

Stenosing digital tenosynovitis

flexor tendon
proximal annular pulley ( MCP joints)

, , , amyloidosis,
hypothyroidism, sarcoidosis, pigmented villonodular tenosynovitis
(sporotrichosis A)

trigger finger trigger thumb
(
)










proximal annular pulley ( metacarpal head) 45

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Hand pain 6

0.5

de Quervains tenosynovitis
abductor pollicis longus extensor pollicis brevis
radius
30-50

Finkelsteins test carpal
tunnel syndrome, trigger thumb trigger finger
radial de Quervains
tenosynovitis (first carpometacarpal joint)
( anatomical snuff box) extensor
carpi radialis longus extensor carpi radialis brevis
abductor pollicis logus extensor pollicis bravis



radial diviation first MCP joint IP joint


6

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Hand pain 7

Dupruytren Contracture


fibroblast
collagen type III palmar fascia
idiopathic epilepsy, alcohol misuse,
, reflex sympathetic dystrophy
fibrosis nodular plantar fibromatosis, nodular fasciitis popliteal fascia
Peyronies disease Dupruetren diathesis
palmar fascia
flexion deformity ulnar side

fibrous nodule fibroblast
palmar fascia


positive top table test




Dupreutron diathesis

: Listers tubercle (
radius) extensor pollucis longus
Lister tubercle ulnar side extensor pollicis longus

de Quervains tenosynovitis: dorsoradial approach

7

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Hand pain 8

Carpal tunel syndrome : medain nerve palmaris longus radial

distal wrist crease ulnar side palmaris tendon

First MCP : joint line 2-4

MCP, PIP, DIP : dorsoradial dorsoulnar

Trigger finger : proximal annular pulley metacarpal head

0.5 tendon sheath

1. Klipple JH, Dieppe PA. eds. Rheumatology 2nd ed, Mosby : Philadelphia 1994
2. Ball GB, Koopman WJ. Clinical Rheumatology. Philadelphia : WB Saunders, 1986
3. Schumacher HR. Primer on the Rheumatic Diseases. 10th ed. Atlanta : Arthritis Foundation, 1993