Hand and Wrist Examination Flashcards
Where are Bouchard’s nodes present?
The proximal interphalangeal joints
Where are Herberden’s nodes present?
The distal interphalangeal joints
What may wasting of the thenar and hypothenar eminences indicate?
Disuse atrophy as well as LMN lesions
Where do you assess median nerve sensation?
Thenar eminence and index finger
Where do you assess ulnar nerve sensation?
Hypothenar eminence and little finger
Where do you assess radial nerve sensation?
Test sensation over the first dorsal webspace
What does tenderness of the anatomical snuffbox indicate?
Scaphoid fracture
How do you get a patient to extend their fingers?
‘Open your fist and splay your fingers’
How do you get a patient to flex their fingers?
‘Make a fist’
What is the normal range of movement for wrist extension?
90 degrees
How do you get a patient to extend their wrist?
‘Put the palms of your hands together and extend your wrists fully’
What is the normal range of movement for wrist flexion?
90 degrees
How do you get a patient to flex their wrist?
‘Put the backs of your hands together and flex your wrists fully’
What nerves are you assessing when you extend the wrist and fingers against resistance?
Radial nerve
What muscles are you assessing when you extend the wrist and fingers against resistance?
Extensors of the wrist and fingers
What nerves are you assessing when you abduct the index finger against resistance?
Ulnar nerve
What muscles are you assessing when you abduct the index finger against resistance?
First dorsal interosseous (FDI)
What nerves are you assessing when abduct the thumb against resistance?
Median nerve
What muscles are you assessing when abduct the thumb against resistance?
Abductor pollicis brevis
What is the function of Tinel’s test?
Used to identify median nerve compression (useful in diagnosis in carpal tunnel syndrome)
What is a positive result of Tinel’s test?
If the patient develops tingling in the thumb and radial two and a half fingers - suggestive of median nerve compression
What is the function of Phalen’s test?
To further support the diagnosis of carpal tunnel syndrome (reverse prayer)
What is a positive result of Phalen’s test?
Burning, tingling or numb sensation in the thumb, index, middle and ring fingers
What further assessments and investigations should be completed after a hand and wrist exam?
- Neurovascular exam of the upper limbs
- Examination of the elbow joint and shoulder joint
- Further imaging
