Examination of Hand and Wrist Flashcards
How do you position the patient
Patients hands resting on a pillow
Wat are you inspecting?
Look for scars
Wounds
Thinning of skin
Rashes
Nails - for signs of clubbing, psoriatic changes (pitting onycholysis) splinter haemorrhage, nail fold vasculitis
Posture of hand and wrist (any fracture or deformity)
Muscle wasting
Bouchard’s nodes (PIP join) and Heberden’s nodes (DIP joint)
Dupuyten’s disease
What do you feel for?
Temperature
Pulse
Muscle bulk (thenar and hypothenar eminences)
Sensation of median (tip of index finger + thenar eminence), ulnar (tip of little finger and hypothenar eminence) and radial (first web space on dorsum of hand) nerves
Palpate for tenderness
Bimanual palpation on joints that are swollen or painful for tenderness and fluctuation
Palpate the MCP and wrist joint with thumbs above and index fingers below
What do you move?
Straighten fingers
Make a fist
(check allignment)
Prayer sign
Revers prayer sign
(actively and then passively)
Phalen’s test
and/or
Tinel’s test
Assess radial,median and ulnar nerve power
How do you assess function?
Ask patient to grip your two fingers
Pincer: ask patient to pick up a small object