Examination of the hand & wrist

Question 1

What are the four main principles to follow when examining the hand & wrist?

Answer 1

1. Look (inspect)
2. Feel (palpate)
3. Move (passive)
4. Function (active)

Question 2

You are currently inspecting the hand. What specifically are you looking for in regards to arthroses? (5)

Answer 2

• muscle wasting
• scars
• nail changes
• deformities of the hand/wrist
• joint/tendon swelling

Question 3

Where are you mainly looking for muscle wasting? (2)

Answer 3

• intrinsic hand muscles
• thenar & hypothenar eminences

Question 4

Which nail changes are you looking for? What do these changes indicate?

Answer 4

• pitting or onycholysis
• seen in psoriatic arthritis

Question 5

Now you are palpating the joints. Which joints will you palpate and what are you looking for?

Answer 5

• palpating wrists, MCPs and IPs
• comparing side to side
• distinguishing soft tissue from bony swelling

Question 6

Is there anything else you should palpate? Why?

Answer 6

Yes, the flexor tendons
- may be thickened due to tenosynovitis

Question 7

Describe the “hand dance” to access active movements of the joints.

Answer 7

• make a fist
• prayer position (hand ext.)
• reverse prayer (hand flex.)
• extend elbows fully
• bend elbows fully
• hands behind head

Question 8

Do we always follow up with passive movements? Why or why not?

Answer 8

No, if they can perform active movements alright we don’t have any reason to check passive movements
- only used to rule out why they can’t do an active movement

Question 9

Let’s say the pt cannot do active movements very well. How would you continue with the passive movement examinations?

Answer 9

• wrists –> flexion & extension
• fingers –> flexion & extension

Question 10

I will also examine the thumb specifically for _______.

Answer 10

abduction power

Question 11

To conclude the exam, which functional assessments could you do?

Answer 11

• pinch grip (opposition)
• power grip (squeeze my finger)
• using buttons
• writing / turning a key