tailieunhanh - Care of Musculoskeletal Problems in the Outpatient Setting - part 5

Tham khảo tài liệu 'care of musculoskeletal problems in the outpatient setting - part 5', y tế - sức khoẻ, y học thường thức phục vụ nhu cầu học tập, nghiên cứu và làm việc hiệu quả | 138 . Shahady interphalangeal DIP and proximal interphalangeal PIP joint dislocation and ligamentous tears as well as fractures of various bones. Ask about osteoarthritis OA and rheumatoid arthritis RA in other joints of the body as both diseases can produce some characteristic hand problems that need to be recognized and treated. Trauma no matter how insignificant can produce significant injury to an arthritic joint. 2. Focused Physical Examination Start by observing for deformities swelling and discoloration. Do this on both the palmar and the dorsal surfaces of the hands and fingers. The usual position of the hand is a flexed position as the flexors of the metacarpals and fingers are stronger than the extensors Figure . Observe for any deviation from the usual anatomic position. Next ask the patient to extend and flex the metacarpal phalangeal MCP joints Figures and the PIP joints Figures and and the DIP joints Figures and . 3. Case . History A 30-year-old male construction worker comes to your office after being hit on the dorsum top of his hand with a piece of machinery 1 day ago. He noted immediate swelling and some tenderness on the dorsal side of hand. He Figure . Flexion as the dominant hand position. 8. Hand Problems 139 Figure . Extension of the MCP PIP and DIP joints. placed some ice on it and the discomfort subsided. He was able to work a few more hours but was then sent home because of the pain. The next day he went to work but was unable to use the hand without pain. The examination reveals some swelling over the dorsum of the hand and early ecchymosis. Most tenderness is over the shaft of the third metacarpal. You ask him to flex his fingers into his palm and note that the middle finger is in an unusual position Figure . The fingers should all point in a similar direction as noted in Figure . Figure . Flexion of MCP joint. 140 . Shahady Figure . PIP flexion. Figure . Flexion of the DIP .