Hand

Question 1

How do you start the examination?

Answer 1

Wash hands
Introduction
Identification
Consent

Question 2

How do you position the patient to begin with?

Answer 2

Seated with hands supine on a pillow

Question 3

What do you ask before starting?

Answer 3

Do you have any pain/numbness

Question 4

What 5 signs do to with the nails do you look for?

Answer 4

Pitting/ridges (psoriosis)
Onycholysis (seperation)
Onychogryphosis (claws)
Splinter haemorrhages
Clubbing

Question 5

What do you look for on the dorsum/palm?

Answer 5

Skin
Muscle wasting
Deformity

Question 6

What skin changes do you look for?

Answer 6

Colour (pink/white/blue)
Changes (sclerodactyly/ulceration)
Psoriosis
Scars

Question 7

Where do you see muscle wasting and what might it mean?

Answer 7

1st dorsal interossi
Guttering
Ulnar nerve damage

Question 8

What sort of deformities do you look for (dorsum)?

Answer 8

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

Question 9

What wasting/deformities do you look for on the palm?

Answer 9

Muscle wasting

Dupuytrens contracture

Question 10

What muscle wasting indicates what nerve damage?

Answer 10

Thenar - median

Hypothenar - ulnar

Question 11

What do you feel for on palpation?

Answer 11

Temperature
Tenderness
Swelling
Bony deformities
Sensation
Vascular status

Question 12

How do you assess for tenderness?

Answer 12

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

Question 13

How do you assess the neuro status?

Answer 13

Perform light touch in dermatome (6,7,8) and peripheral nerve distributions

Question 14

How do you assess the vascular status?

Answer 14

Ulnar and radial pulses

Allen’s test

Question 15

How do you assess ROM in the fingers?

Answer 15

Flexion/extension - make fist and extend fingers

Abduction/adduction - extend and spread fingers

Question 16

How do you assess ROM in the thumb?

Answer 16

test:
Flexion
Extension
Palmar abduction
Adduction
Opposition

Question 17

How do you assess ROM of the wrist?

Answer 17

Prayer and reverse prayer signs

Radial and ulnar deviation with elbows tucked

Question 18

When do you assess passive ROM?

Answer 18

If there is a limited range of movement

Question 19

How do you assess function?

Answer 19

Hold a pen and don’t let me pull it out
Hold a pen or key normally
Can they do up buttons?

Question 20

What are the special tests for carpal tunnel

Answer 20

Sensation (median nerve distribution)
Motor
Provocation tests

Question 21

What is the motor special test for carpal’s tunnel?

Answer 21

Palmar abduction against resistance

thumb up to ceiling with palm flat, push down with your thumb

Question 22

What are the provocation tests for carpal tunnel?

Answer 22

Tinel’s
Phalen’s
Compression

Question 23

What is tinel’s test?

Answer 23

Tap strongly over median nerve in carpal tunnel area

Pain, numbness or tingling is +ve

Question 24

What is phalen’s test?

Answer 24

Hold both wrists in palmar flexion for 1 min (reverse prayer)
pain, numbness tingling…

Question 25

What is the compression test?

Answer 25

Apply direct pressure over area

pain numbness tingling…

Question 26

What tests do you do for ulnar nerve pathology?

Answer 26

Sensation
Cross index and middle fingers
Grip paper with straight thumb and first finger
Abduct fingers against resistance

Question 27

What tests do you do for radial nerve pathology?

Answer 27

Sensation in the anatomical snuffbox

Wrist and finger dorsiflexion against resistance

Question 28

What do you state at the end?

Answer 28

I would do a full examination of the ipsilateral elbow

Question 29

How do you finish the examination?

Answer 29

Thank patient
Wash hands
Present