H&P Hand

Question 1

Flexor

Answer 1

Volar

Question 2

Extensor

Answer 2

Dorsal

Question 3

Radial

Answer 3

Lateral

Question 4

Ulnar

Answer 4

Medial

Question 5

Pronation and supination of the hand occurs where?

Answer 5

Forearm

Question 6

Joints in the Hand

Answer 6

Carpo-metacarpal

Metacarpal-phalangeal

Question 7

Joints in the Fingers

Answer 7

Metacarpal-phalangeal (MP)
Proximal Interphalangeal (PIP)
Distal Interphalangeal (DIP)

Question 8

ROM of Writs

Answer 8

Radial and ulnar deviation (Abbduction and adduction)

Flexion and extension

Question 9

The distal pivot joint of pronation and supination in the wrist

Answer 9

Distal radial-ulnar joint

Question 10

What is deep to the anatomical snuff box

Answer 10

Scaphoid bone

Question 11

Sensory supply for the dorsum of the thumb and the dorsal 2/3 of the index, middle and ring fingers

Answer 11

Radial nerve

Question 12

Motor for the wrist extensors

Answer 12

Radial nerve

Question 13

Sensory for the volar thumb, index, middle and radial aspect of ring finger

Answer 13

Median nerve (meatloaf tips)

Question 14

Motor for the thenar muscle

Answer 14

Median nerve

Question 15

Sensory for the ulnar aspect of the ring finger and all of small finger

Answer 15

Ulnar nerve

Question 16

Motor for intrinsic muscles of the hand

Answer 16

Ulnar nerve

Question 17

Nerves located on volar side of digit

Answer 17

Digital nerves

Question 18

Digital nerves

Answer 18

Should be able to discriminate between 1 and 2 points ~6mm apart on fingers
Each finger has a radial and digital nerve-run on volar side of each digit

Question 19

ROM of Elbow, Wrist, Hand

Answer 19

Compare both sides for symmetry
Elbow: Flexion, extension, pronation, supination
Wrist: Flexion, extension, radial/ulnar deviation
Thumb: Abduction, adduction and opposition

CMC joints: Minimal motion except thumb CMC joint
MP joints: Flexion, extension, hyperextension
PIP joints: Flexion, extension
DIP joints: Flexion, extension

Question 20

Medical Conditions Manifested in the Hand

Answer 20

Smoking-Raynaud's
RA
Gout
OA-Heberden's nodes and Mucous cysts
Cancer-Skin cancers, Bone tumors
Diabetes-Peripheral neruopathy, carpal tunnel
Thyroid Dz-Hair/nail changes
Psoriasis-Nail deformity, Psoriatic arthropathies, pitting
Infectious

Question 21

Pertinent Hand Hx

Answer 21

For specific hand complaints, evaluate all cardinal features of the patient’s complaint.
Medical Hx: Diabetes, thyroid, RA, gout, psoriasis
Surgical Hx: Any previous upper extremity or neck surgeries (downstream neurogenic or vascular compromise)
Dominant hand
Occupation Hx
Recreational interests/hobbies
Previous injuries-neck or upper extremity trauma

Question 22

Hand Inspection

Answer 22

Inspect/compare both sides when possible; note swelling or obvious signs of trauma; look for any muscle atrophy; look for joint deformity, Herberden’s nodes (OA); scars; nicotine staining; moles/skin cancer; hair nails-distribution and consistency of hair, consistency of nails and pitting, clubbing of fingertips

Question 23

Hand Palpation

Answer 23

Skin temp; radial and ulnar pulses; Allen’s test; palpate each joint for swelling and tenderness; palpate the skin of the palm for fascial thickening

Question 24

ROM of all joints of the hand

Answer 24

Compare to contralateral side

Question 25

Tendon exam of the hand: Extensor Mechanism

Answer 25

Except the thumb, each digit has one extensor tendon

Extensor Digitorum Communis (EDC) 2-5

Question 26

Tendon exam of the hand: Flexor Mechanism

Answer 26

Except the thumb, each digit has two flexor tendons
Flexor Digitorum Superficialis (FDS) flexes the PIP joint
Flexor Digitorum Profundus (FDP) flexes the DIP joint

Question 27

Tendon exam of the hand: The Thumb

Answer 27

Two extensor tendons (EPL, EPB) and one flexor tendon (FPL)

Question 28

Joint Exam of the Hand

Answer 28

Inspect for swelling, deformity
OA will generally affect DIP (Herberden’s nodes) and PIP (Bouchard’s nodes)
RA will affect MP joints and the wrist-all joints can be affected
Palpate for warmth, crepitus, clunking, ligament instability, masses
Passive motion if patient is unable to perform AROM

Question 29

Phalen’s Test

Answer 29

Test for Carpal Tunnel Syndrome

Hyperflex both wrists and asses for median nerve paresthesias; test for up to 60 seconds

Question 30

Tinel’s Test

Answer 30

Test for Carpal Tunnel Syndrome
Tap on Median nerve at wrist (directly deep to the palmaris longus tendon)
If positive, will send a shock or tingle into median nerve distribution

Question 31

Froment’s Sign

Answer 31

For ulnar nerve compression
Have pt try to pinch a piece of paper between thumb and index finger
If positive, thumb IP will flex and pinch strength will likely be weak

Question 32

Pope’s Blessing

Answer 32

Sign of Ulnar nerve compression
On inspection, will notice atrophy in the intrinsic muscles, esp between thumb and index finger
Will notice clawing of 4th and 5th digits in late disease

Question 33

Finkelstein’s Maneuver

Answer 33

For DeQuervian’s Tenosynovitis
Tuck thumb into fist and forcefully deviate the wrist in an ulnar direction
Positive test will cause pain
May also paplate crepitus or squeaking over the tendons during exam

Question 34

Grind Test

Answer 34

For Thumb CMC Arthritis
Place axial load on thumb metacarpal as you toggle the joint through 180 degrees of rotation
Positive if pain and crepitus noted over CMC joint

Question 35

Flexor Tendon Exam: Trigger Finger

Answer 35

Palpate over MP joints during ROM exam
Feel for clunking of synovial “knot” passing thru the pulley
Feel for clunk or lock on extension of finger

Question 36

Flexor Tendon Exam: Tendon laceration

Answer 36

Evaluate if each tendon is intact

Question 37

Flexor Tendon Exam: Digital Nerve laceration

Answer 37

2 digital nerves per finger
They both travel on the volar side of the finger and just radial and ulnar to the flexor tendon unit
Eval nerve function BEFORE administering anesthesia to repair a lac