Search Results

175 results found

  • A reliable way to palpate lunate and capitate

    Anatomical relationship of palmar carpal bone landmarks used in locating the lunate and capitate during palpation: A cadaveric investigation Davis, A., Wilhelm, M., Pendergrass, T., Sechrist, D., Brismée, J., Sizer, P., & Gilbert, K. (2019) Level of Evidence: N/A Follow recommendation: N/A Type of study: Anatomical Topic: Carpal bone landmarks - Cadaveric study This anatomical study performed on 25 cadavers, on average 75 years old, identified four reliable ways of locating the capitate on the palmar aspect of the wrist and one reliable way of determining the position of the lunate on the dorsal aspect of the wrist (all 100% correct). The capitate was located by identifying the midpoint of the line between the scaphoid tubercle/trapezium tubercle and pisiform/hook of hamate. Alternatively, the crossing point between these lines could be used. Lunate was located correctly when the midpoint between the radial and ulnar styloid line was found on the dorsal aspect of the wrist. Clinical Take Home Message: Hand therapists can use the well-defined landmarks of the trapezium and scaphoid tubercle, pisiform, and hook of hamate to identify the position of the capitate palmarly. This may be useful in identifying capitate fractures, which occur in 1.3% of all carpal fractures, and capitate stress fractures occasionally identified in gymnasts. The correct identification of lunate's position may help differentiating between symptomatic presentation of lunotriquetral, scapholunate instability, or Kienböck's Disease. URL:

  • Physical tests for cervical radiculopathy

    Value of physical tests in diagnosing cervical radiculopathy: A systematic review Thoomes, E., van Geest, S., van der Windt, D., Falla, D., Verhagen, A., Koes, B., Thoomes-de Graaf, M., Kuijper, B., Scholten-Peeters, W., & Vleggeert-Lankamp, C. Level of Evidence: 1a Follow recommendation: 👍 👍 👍 👍 Type of study: Diagnostic Topic: Cervical radiculopathy – Physical tests This is a systematic review assessing the usefulness of physical tests in making a diagnosis of cervical radiculopathy in patients with a disk herniation or osteoarthritic changes. Five papers, which compared physical test results against MRI/CT scans or surgical findings were included. The variables of interest were the sensitivity and specificity of physical tests. If a test is very sensitive and its result is negative, you can be more certain that the patient does not have the condition. If the test is specific and its result is positive, you can be more certain that the patient has the condition. Spurling’s test and cervical distraction test showed high specificity and low sensitivity. Upper limb neurodynamic tests showed high sensitivity and low specificity. The arm squeeze test showed high sensitivity and high specificity. The arm squeeze test is performed by compressing the anterior and posterior mid portion of the patient’s arm. The test is considered positive if compression of the arm is 3/10 points more painful than squeezing the patient’s shoulder joint. The cervical distraction test showed high specificity and low sensitivity. The cervical distraction test is considered positive when manual cervical traction relieves symptoms in the upper limb. Clinical Take Home Message: Hand therapists may use a combination upper limb neurodynamic test, and arm squeeze test to rule out a radiculopathy. If neurodynamic tests do not elicit pain and the arm squeeze test is negative, the presence of a radiculopathy is less likely. A diagnosis of cervical radiculopathy can be made if the arm squeeze test and Spurling’s test are positive, and if the cervical distraction test relieves pain. URL:

  • "When can I drive?" - Distal radial fracture

    Driving performance following a wrist fracture: A pilot study using a driving simulator Stinton, S., Pappas, E., Edgar, D., & Moloney, N. Level of Evidence: 3b Follow recommendation: 👍 👍 Type of study: Preventative Topic: Return to driving - Radius fracture ORIF This is a pilot study assessing patients' fitness to drive after a distal radius fracture. All distal radius fractures were treated through open reduction and internal fixation (ORIF). The ORIF group (n = 6) was compared to a healthy uninjured group (n = 16). All the participants were assessed through a driving simulator. The ORIF group was assessed at two time points (5/52 and 7/52 post surgery) while the control group was assessed at one time point only. The results of this study need to be considered in the context of a few limitations. The sample size was small and it is possible that a larger study would provide different results. In addition, the validity of the driving simulator has not been assessed and we are not sure whether the results obtained from this test are able to identify people at higher risk of a car accident. At the first assessment point (5/52 post surgery), the results showed that the ORIF group spent a greater proportion of time out of their lane (ORIF: 13% vs Control: 0.2%), which represents a risky driving behaviour. Also at the first assessment point (5/52 post surgery), the time spent over the speed limit was lower for the ORIF group (3%) compared to the control group (16%), suggesting that the ORIF group had a safer driving behaviour. At the second assessment point (7/52 post surgery), the ORIF group was no different compared to the control group, suggesting that their driving behaviour had normalised. Clinical Take Home Message: At five weeks after distal radius fracture ORIF, patients will drive slower compared to their peers, but will present with worse car control. Hand therapists may encourage patients to practice driving in a safe environment (e.g. empty parking lot) before driving on the road, which may help in improving car control. In addition, patients may check with their insurance company requirements (e.g. surgeon's clearance) before engaging in driving. URL:

  • Elbow stabilisers and how to test them

    Elbow biomechanics: Soft tissue stabilizers Kaufmann, R., Wilps, T., Musahl, V., & Debski, R. Level of Evidence: N/A Follow recommendation: N/A Type of study: Anatomical Topic: Elbow ligaments - Biomechanics This is a narrative review on the passive elbow structures contributing to valgus and varus stability of the elbow joint. No systematic process was followed. The authors report that valgus flexibility at the elbow is greatest at 30° of flexion. The medial ulnar collateral ligament (MUCL) resists these valgus forces. The MUCL is divided in anterior and posterior bundles, with the anterior bundle being the main source of valgus stability. The MUCL (anterior bundle) tightens incrementally with elbow flexion, reaching highest tension at 80° of elbow flexion. The anterior and posterior portion of the MUCL (anterior bundle) are stretched during full elbow extension and flexion respectively. The lateral collateral ligaments of the elbow passively control varus forces and they consist in the lateral ulnar collateral ligament (LUCL) and the radial collateral ligament (RCL). The stabilisation role of the two is debated, however, it is believed that both control varus forces and are important in the postero-lateral rotatory stability of the elbow. Clinical Take Home Message: Hand therapists could perform valgus stress testing in 30° of elbow flexion to reveal the greatest laxity. Valgus testing in full elbow extension and flexion should reveal greater stability and they will stress the anterior and posterior portions of the MUCL respectively. Injury to the lateral collateral ligaments should alert clinicians to the possibility of patients presenting with postero-lateral rotatory instability of the elbow. URL:

  • Answer - What is the differential diagnosis for this condition? - Wrist ganglion

    Synovial hemangioma of the wrist with cystic invasion of trapezoid and capitate bones Zhao, X., Qi, C., Chen, J., Li, H., Zhang, Y., & Yu, T. Level of Evidence: 5 Follow recommendation: 👍 Type of study: Diagnostic/Therapeutic Incidence: Rare Topic: Synovial Haemangioma - Diagnosis and treatment This is the answer for the case study from last week. The patient was an 18 year old male who had been experiencing pain and swelling in the back of the wrist in the last 2 years. Objectively, there was a 3x3 cm non-pulsatile mass in the back of the wrist. Extension range of movement had a deficit of 20 degrees. X-ray was impeccable, however, computer tomography and MRI scans revealed an ill-defined soft tissue mass between scaphoid, trapezoid, and capitate. Following surgery, it was possible to make a diagnosis of wrist synovial haemangioma. Synovial haemangiomas are rare benign tumours which usually affect children or young adults. Only 300 cases have been reported in the literature, most of which occurred in the knee. Symptoms vary and intermittent pain may be present or absent. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message: Hand therapists should refer young children or teenagers for x-rays and ultrasound when there is evidence of an irregularly shaped, soft mass which appears to or is reported to have grown over time. The likelihood of identifying a synovial haemangioma is extremely rare, however, this work up would help differentiating among different conditions including ganglion cyst, rheumatoid arthritis, haematomas associated with haemophilia, infections or other rare forms of cancer. URL: Available through The Journal of Hand Surgery (American Volume) for HTNZ members. Available through EBSCO Health Databases for PNZ members. Abstract Synovial hemangiomas (SHs) are rare lesions of the joints or tendon sheaths that are difficult to diagnose. We present the case of an 18-year-old man with an SH in the wrist joint. Physical examination revealed a slightly tender, ill-defined, nonpulsatile soft mass, 3 cm × 3 cm in size on the dorsal aspect of the left wrist. Computed tomography showed an irregular, ill-defined, soft tissue mass in the expanded joint space, which was formed by the scaphoid, trapezoid, and capitate bones. Magnetic resonance imaging showed the typical features of SH and also revealed cavitary erosion of the scaphoid, trapezoid, and capitate bones. An open arthrotomy was performed via a dorsal approach, and the mass was excised. The histological examination findings were consistent with the diagnosis of SH.


by Dr Nico Magni

HTNZ logo.png

Contact me at:

© 2020-2021 HandyEvidence by Dr Nico Magni