CLIN MSK Elbow, Wrist, Hand & Finger Exam Flashcards
Process of MSK Elbow, Wrist, Hand & Finger Examination
- HH
- Greet pt
- Introduce yourself
- Identify pt
- Explanation of examination & confidentiality
- Discuss exposure – shoulders should be fully exposed (upper body exposed to the waist with bra/crop top on for female pts).
- Obtain consent
- Position the pt
- Ask whether the pt is comfortable
- Ask the pt if they are in pain or experiencing any discomfort before the exam.
- General Inspection
- Look – from front, sides & behind
- Feel (normal joint first then joint of complaint)
- Move – pt standing up
- Special Tests
- Thank pt
- Redress
- Report findings
- Ask if any questions for pts
- HH
Process of General Inspection
a. Aids – specific to exam (e.g., casts/sling)
b. Pain/discomfort
Process of Look for Elbow
a. Symmetry
b. Scars
c. Rashes
d. Bruising
e. Erythema/redness
f. Swelling
i. Rheumatoid nodules
ii. Gouty Tophi
iii. Enlarged bursa
g. Deformity
h. Muscle wasting/bulk
i. Abnormal bone alignment
j. Posture
k. Contour
l. Carrying angle
Process of Feel for Elbow
a. Skin warmth – w back of fingers
i. Active synovitis – swollen & slightly warm joint
ii. Infection
iii. Crystal arthritis (e.g., gout).
b. Tenderness – mainly over medial and lateral epicondyles
c. Swelling
i. Rheumatoid nodules
ii. Gouty Tophi
iii. Enlarged bursa (specifically fluid collection in the olecranon bursa)
d. Bone swelling – hard & immobile (suggesting osteophyte formation/subchondral bone thickening).
e. Bony landmarks – check both sides of pt
i. Olecranon
ii. Medial epicondyle
iii. Lateral epicondyle
iv. Ulnar nerve (in the ulnar groove)
Process of Move for Elbow
a. Active
i. Flexion 150
ii. Extension 0
iii. Supination 90 – w pt’s arms handing down at the side of the trunk and their elbows flexed
iv. Pronation – as above
b. Passive – comment on presence/absence of crepitus (be aware in presence of fracture)
i. Flexion 150
ii. Extension 0
iii. Supination 90 – w pt’s arms handing down at the side of the trunk and their elbows flexed
iv. Pronation – as above
Special Tests for Elbow
a. Golfer’s Elbow Test (medial epicondylitis) – palpate medial epicondyle, elbow full extension, supinate, flex wrist & resist.
b. Tennis Elbow Test (lateral epicondylitis) – palpate lateral epicondyle, elbow full extension, pronated, wrist extended w clenched fist & resist.
Process of Look for Wrist
a. Symmetry
b. Scars
c. Rashes
d. Bruising
e. Erythema/redness
f. Mass deformity
i. Ganglions
ii. Synovitis/swelling
iii. Ulnar deviation
g. Swelling
h. Muscle wasting/bulk
i. Posture
j. Contour
Process of Feel for Wrist
a. Skin warmth – w back of fingers
b. Tenderness
c. Swelling
d. Bony landmarks – check both sides of pt
i. Thenar eminence
ii. Hypothenar eminence
iii. Ulnar styloid
iv. Radial styloid
v. Lister’s tubercle
vi. Scaphoid
vii. Trapezium
viii. Trapezoid
ix. Capitate
x. Lunate
xi. Pisiform
xii. Triquetrum
xiii. Hamate
Process of Move for Wrist
a. Active
i. Flexion 75
ii. Extension 75
iii. Radial deviation 20
iv. Ulnar deviation 20
b. Passive – comment on presence/absence of crepitus (be aware in presence of fracture)
i. Flexion 75
ii. Extension 75
iii. Radial deviation 20
iv. Ulnar deviation 20
Special Tests for Wrist
a. Phalen’s Test (carpal tunnel syndrome) - pt actively flexes both wrists for 30s
b. Tinel sign (carpal tunnel syndrome) - percuss median nerve on volar surface of pt’s wrist
Process of Look for Hand/Fingers
a. Symmetry
b. Scars
c. Rashes
d. Bruising
e. Erythema/redness
f. Lumps
g. Swelling
h. Muscle bulk/wasting – particularly of the thenar/hypothenar eminences
i. Posture & contour
i. Trigger Finger
ii. Dupuytren’s Contracture
j. Ask the pt to make a fist
k. Deformity
i. Nodules
1. @ DIP Hemberden’s (Osteoarthritis)
2. @ PIP Bouchard’s (Osteoarthritis)
3. Rheumatoid Nodules (Rheumatoid Arthritis)
4. Gouty Tophi
ii. Rheumatoid Shapes
1. Swan Neck (Rheumatoid Arthritis)
2. Z of the thumb (Rheumatoid Arthritis)
3. Boutonnieres (Rheumatoid Arthritis)
4. Ulnar deviation (Rheumatoid Arthritis)
iii. Other
1. Sausage shaped fingers/Dactylisis (psoriatic arthropathy)
2. Mallet finger
3. Pitting of nails (psoriasis)
Process of Feel for Hand
a. Skin warmth – w back of fingers
b. Tenderness
c. Swelling
d. Tendon thickening
e. Bony landmarks – check both sides of pt
i. Phalanges
ii. DIP
iii. PIP
iv. MCP
v. MC
Process of Move for Hand
a. Active
i. Global fist and release (w thumbs tucked in)
ii. Flexion 90
iii. Extension 30
iv. Abduction & adduction (test w hand on a flat surface)
v. Thumb movements
1. Flexion
2. Extension
3. Abduction
4. Adduction
5. Opposition
b. Passive – comment on presence/absence of crepitus (be aware in presence of fracture)
i. Flexion 90
ii. Extension 30
iii. Abduction & adduction (test w hand on a flat surface)
iv. Thumb movements
1. Flexion
2. Extension
3. Abduction
4. Adduction
5. Opposition
Special Tests for Hand Function
i. Grip strength – pt squeezes 2 x examiner’s fingers
ii. Key grip – pt holds key between pulps of thumb & forefinger and examiner attempts to open fingers.
iii. Opposition strength – patient opposes thumb and individual fingers and examiner tries to force these apart
iv. Practical test – pt writes something w pen
Special Tests of Provocation for Hand
i. Phalen’s Test (carpal tunnel syndrome) - pt actively flexes both wrists for 30s
ii. Tinel sign (carpal tunnel syndrome) - percuss median nerve on volar surface of pt’s wrist
iii. Finkelstein Test (De Quervain’s Tenosynovitis/Tendinitis) – pt flexes thumb of one hand and then makes a fist by wrapping the fingers of the same hand around the thumb, then ulnar deviation.
