Hand Flashcards
How do you start the examination?
Wash hands
Introduction
Identification
Consent
How do you position the patient to begin with?
Seated with hands supine on a pillow
What do you ask before starting?
Do you have any pain/numbness
What 5 signs do to with the nails do you look for?
Pitting/ridges (psoriosis) Onycholysis (seperation) Onychogryphosis (claws) Splinter haemorrhages Clubbing
What do you look for on the dorsum/palm?
Skin
Muscle wasting
Deformity
What skin changes do you look for?
Colour (pink/white/blue)
Changes (sclerodactyly/ulceration)
Psoriosis
Scars
Where do you see muscle wasting and what might it mean?
1st dorsal interossi
Guttering
Ulnar nerve damage
What sort of deformities do you look for (dorsum)?
Fusiform/focal swelling (AS/IBD) (psoriotic arth) Nodules (bouchards/herbedens) (OA) Swan neck/boutonniere (RA) Squaring of hand at 1cmcj (OA) Windswept deformitiy (RA) Clawing Wrist swelling
What wasting/deformities do you look for on the palm?
Muscle wasting
Dupuytrens contracture
What muscle wasting indicates what nerve damage?
Thenar - median
Hypothenar - ulnar
What do you feel for on palpation?
Temperature Tenderness Swelling Bony deformities Sensation Vascular status
How do you assess for tenderness?
Start at the wrist
Perform MCPJ squeeze (localise to one joint if painful)
Palpate dorsal and volar metacarpals and phalanges
Palpate radial and ulnar aspects of phalanges
How do you assess the neuro status?
Perform light touch in dermatome (6,7,8) and peripheral nerve distributions
How do you assess the vascular status?
Ulnar and radial pulses
Allen’s test
How do you assess ROM in the fingers?
Flexion/extension - make fist and extend fingers
Abduction/adduction - extend and spread fingers
How do you assess ROM in the thumb?
test: Flexion Extension Palmar abduction Adduction Opposition
How do you assess ROM of the wrist?
Prayer and reverse prayer signs
Radial and ulnar deviation with elbows tucked
When do you assess passive ROM?
If there is a limited range of movement
How do you assess function?
Hold a pen and don’t let me pull it out
Hold a pen or key normally
Can they do up buttons?
What are the special tests for carpal tunnel
Sensation (median nerve distribution)
Motor
Provocation tests
What is the motor special test for carpal’s tunnel?
Palmar abduction against resistance
thumb up to ceiling with palm flat, push down with your thumb
What are the provocation tests for carpal tunnel?
Tinel’s
Phalen’s
Compression
What is tinel’s test?
Tap strongly over median nerve in carpal tunnel area
Pain, numbness or tingling is +ve
What is phalen’s test?
Hold both wrists in palmar flexion for 1 min (reverse prayer)
pain, numbness tingling…
What is the compression test?
Apply direct pressure over area
pain numbness tingling…
What tests do you do for ulnar nerve pathology?
Sensation
Cross index and middle fingers
Grip paper with straight thumb and first finger
Abduct fingers against resistance
What tests do you do for radial nerve pathology?
Sensation in the anatomical snuffbox
Wrist and finger dorsiflexion against resistance
What do you state at the end?
I would do a full examination of the ipsilateral elbow
How do you finish the examination?
Thank patient
Wash hands
Present
