Hand and Wrist Exam

Question 1

Scene Setting

Answer 1

WIPE
Expose arms below elbow
Place hands on pillow

Question 2

General Inspection

Answer 2

Splints
Supports
Bandages
Gloves

Question 3

Look - Dorsum

Nails
Bones
Skin
Muscles

Answer 3

Deformity
Scarring

Nails:

1. Clubbing
2. Oncholysis or Pitting

Bones:

• swelling of joints
• Heberdens and Bouchards
• Swan neck deformity
• Ulnar deviation
• Z thumb
• Boutonniere deformity

Skin:

• Thinning
• Bruising

Muscles:

• Wasting
• Guttering

Question 4

Look - Palmar

Answer 4

Hand posture - symmetry, ulnar claw, Dupuytrens
Scars - Carpal Tunnel
Swellings
Skin colour - Palmar erythema, pale palmar creases

Question 5

Extensor surfaces

Answer 5

Psoriasis
Rheumatoid nodules
Gouty tofi

Question 6

Feel - Dorsum

Answer 6

Temperature
Squeeze joints
1. Radial - ulnar
2. Radial - ulnar styloid
3. Anatomical snuffbox
4. 8 Carpal bones
5. MCP squeeze
6. Interphalangeal joints
Tendons
Radial Nerve Sensation

Question 7

Feel - Palms

Answer 7

Radial pulses
Muscle wasting
Median nerve
Ulnar Nerve

Question 8

Move - Wrists

Answer 8

1. Flexion - flop
2. Extension
3. Pronation
4. Supination
5. Radial deviation
6. Ulnar deviation
   .

Question 9

Move - Fingers

Answer 9

1. Straighten fingers
2. Make a fist
3. Move each finger passively

Question 10

Move - Thumb

Answer 10

Extension
Flexion - across palm 
Abduction - thumbs in air
Adduction Thumb to palm 
Opposition

Question 11

MOTOR

Answer 11

Resistance

• fingers up
• fingers out
• Thumb up

Question 12

Function

Answer 12

1. Power grip
2. Pincer grip
3. Dexterity

Question 13

Special tests

Answer 13

1. Tinnels test
2. Phalens test
3. Prayer sign

Question 14

To finish

Answer 14

• Elbow joint

- Neurovascular upper limb