Examination Of The Hand

Question 1

1

Answer 1

Intro
Ask the patient if they have any pain or numbness/tingling. Take care not to cause the patient excessive discomfort during your examination

Question 2

2

Answer 2

Inspection (look)
Nails

Question 3

3

Answer 3

Look
Dorsum - 4 things:
Skin
Scars
Muscle wasting
Deformity

Question 4

4

Answer 4

Look
Palmer surface

Question 5

5

Answer 5

Look at the elbow

Question 6

6

Answer 6

Feel - 4 things (remember to ask where it is painful)
1) TEMP

Question 7

7

Answer 7

2) PALPATE: for tenderness, swelling or bony deformities. Start at the wrist and palpate volar, dorsal, radial and ulnar aspects.
-perform a squeeze test of the MCP joints
-If the squeeze test is painful, localise the disease by palpating each MCPJ individually. Place both of your thumbs just distal to the MCPJ on the dorsum of the finger overlying the extensor tendon. Your fingertips should be overlying the head of the metacarpal in the palm.
-Palpate along the dorsal and volar aspect of metacarpals and phalanges (squeeze
gently using your thumb on the palmar surface and index finger on the dorsum).
-Palpate the radial and ulnar aspects of the phalanges.

Question 8

8

Answer 8

3) Neuro - Check sensation in the dermatomes (C6,7,8) and peripheral nerve (median, ulnar, radial) distributions

Question 9

9

Answer 9

4) vascular
-check the ulnar and radial pulses
-perform an Allen’s test

Question 10

10

Answer 10

Assess range of motion

Test active movement first. If a limited range of movement exists, you will need to repeat the movement passively. Take care not to cause the patient excessive discomfort

Fingers
Flexion/extension - Ask the patient to ‘make a full fist’ then straighten fingers.
If this is not possible examine flexion of MCPJ, PIPJ and DIPJ separately.
Abduction/adduction - ask the patient to ‘extend and spread their fingers’ and then back to normal.

Question 11

11

Answer 11

Thumb- flexion, extension, palmar abduction, adduction and opposition

Question 12

12

Answer 12

Wrist - ask the patient to perform the prayer and reverse prayer signs to test dorsiflexion and palmar flexion
Radial and ulnar deviation with elbows by side

Question 13

13

Answer 13

Test function
Assess grip strength
-assess power grip
-assess lateral pinch grip (key grip) by asking the patient to hold a key or pen normally
-assess precision - can the patient undo and do up buttons

Question 14

14

Answer 14

Thank the patient

Question 15

Special tests

Answer 15

These are specific tests for peripheral nerve problems: each nerve has a sensory, motor and provocation test. In the OSCE, you will be instructed as to whether you need to include these tests.
(Look at handbook)