Hand and Wrist Examination

Question 1

Introduction

Answer 1

1 - Introduce Yourself
2 - Confirm patients' details
3 - Explain the procedure
4 - Gain consent
5 - Ask about any pain

Question 2

Pre-procedure

Answer 2

Wash Hands

Put the hands on a pillow

Question 3

First Step

Answer 3

LOOK

Inspection of Hands (Scars, swelling, lesions,
Inspection of Elbows

Question 4

Second Step (5)

Answer 4

FEEL

1 - Temperature
2 - Palpate pulses (radial and ulnar)
3 - Assess thenar and hypothenar bulk
4 - Palmar thickening

Question 5

Third Step

Answer 5

Sensation

Question 6

Fourth Step

Answer 6

Think about the joints

Squeeze Metacarpophalangeal joints
Squeeze interphalangeal joints (distal and proximal)
Bimanual palpation of the wrist joints
Palpate anatomical snuffbox
Palpate ulnar border

Question 7

Fifth step

Answer 7

MOVE

Active (then passive)
Finger/extension of fingers
Wrist extension/flexion at 90º

Then against resistance:
Finger extension (radial nerve)
Finger abduction (ulnar)

Question 8

Sixth step

Answer 8

Special tests

Pincer grip
Ask to pick up a coin

Tinel’s Test
Phalen’s test

Question 9

Closing

Answer 9

Thank the patient
Wash hands

Summarise findings:
“Today I’ve performed a hand/wrist exam at Chloe, a 23 year old female. On inspection of the hands, they had a normal appearance, with no evidence of scards, deformities, or muscle wasting.

On palpation, there was a normal temperature and no pain and tendons and joints. Sensation was normal. Normal range of movement in the hands. In summary, it was a normal hand exammination.”