Hand and Wrist

Question 1

Outline what you would do for inspection

Answer 1

DORSUM OF HANDS

• redness
• swelling/masses
• deformities
• scars
• adequate valleys between the knuckles
• haberdeens nodes
• bouchards nodes
• swan neck deformities
• crooked fingers
• mallet finger
• boutonnières finger
• skin thickening/ thinning
• MCP joints and wrists

NAILS

• onycholysis
• oil spot
• splinter hemorrhages
• splitting
• hyperkeratosis
• discolouration
• pitting
• ridging

PALMS

• thenar atrophy/hypertrophy
• hypothenar atrophy/hypertrophy
• dupytrens contracture
• muscle wasting of the small muscles of the hand
• any discolouration, redness, swelling, spots, callouses.
• swelling along the tendons.

Question 2

what’re you feeling for during palpation

Answer 2

tenderness, warmth, swelling/effusion, crepitus, thickening

Question 3

outline the steps for palpation

Answer 3

palpate for: tenderness, warmth, swelling/effusion, crepitus, thickening

palpate the wrist area for the:
carpal bones
radoiocarpal joint
the radio-ulnar distal joint
on the anterior side, palpate where the carpal tunnel is 
- don't miss the thumb

palpate the MCPS

• for step deformity– fold hand and look for smoothness
• look for valleys of the knuckles
• palpate for crepitus
• ligamentous stability

palpate the PIPs and DIPS

• smoothness of the bone, for any crepitations
• ligamentous stability
• should be around 15-20 degree ligamentous flexion.
• • so a bit of hyperextension.

Palpate the palm of hand

• thenar and hypothenar area
• palpate the small muscles of the hand
• tendons
• MCP on this side
• THICKENING, NODULES, TENDERNESS
• contractures

palpate the radial aspect of the wrist
- the anatomical snuff box for the extensor pollicis longs and extensor polices braves

Question 4

outline the range of motion and strength test

Answer 4

ROM active:
pronation
supination
flexion
extension 
radial side abduction
ulnar side adduction 
make a fist
karate chop
abduct fingers
adduct fingers
opposition fingers
ABDUCT/ADDUCT/EXTEND/FLEX the THUMBS

ROM passive: 
prnation
supination
flexion 
extension
radial abduction
ulnar adduction
make a fist
abduction hand
adduction hand 

ROM strength:
all of active

Question 5

what is next after ROM and strength testing

Answer 5

neurovasc test:

sharp/soft test using–
medial nerve=palm
radial nerve = pointer dorsum
ulnar nerve = lateral pinky

• cap refill
• radial pulse

Question 6

special tests

Answer 6

for carpal tunnel

• compression test
• tinel tap test
• phalanx test
• reverse phalens test

for tenosinovitis
- finkelsteins test

for blood flow
Allens test