Hand Exam Flashcards
Nerve damage in ape hand
Median Nerve
Nerve damage in claw hand
Median/ulnar nerve
Nerve damage in bishop’s hand
Ulnar nerve
Nerve damage in wrist drop
Radial Nerve (extensors don’t work yanno)
What are we observing in appearance for a hand evaluation?
UE/head/neck position Gross atrophy Edema Tone Scars Color Moisture (ew) Deformed nails Contractures
What are Bouchard’s nodes?
Swelling in PIPs
What are Heberden’s nodes?
Swelling in DIPS
What is mallet finger?
Straight PIPs, flexed DIP
Swan neck contracture
Extended PIP, flexed DIO+P
Boutonnière Contracture
Flexed PIP, extended DIP
More than 10 mL difference in volumetric measurements
“Archimede principle of water displacement”
Means swelling!
Procedure for edema measurement in hand
1- Overfill tank slightly, let water drain
2- Immerse limb slowly until 3rd web hits stop rod, collect displaced water in graduated cylinder
3- Record graduated cylinder volume in mL
For edema measurement, what amount of displaced water represents swelling?
More than 10 mL
Variables that decrease accuracy of hand edema measurement
- aerated hose
- limb motion
- inconsistency of pressure on stop rod
For all digital measurements keep wrist _______.
Why?
Neutral–avoid tension from opposing extrinsic muscle groups
How to perform digital ROM:
1- measure mP flexion in intrinsic positive mosition
2- Measure PIP/DIP flexion together with MP in extension
-Stabilized/blocked/isolated ROM (not complete flexion)
3- After flexion measurements, record ext. by asking for composite extension
What is TAM?
Sum of active flexion measurements at MP, PIP, DIP, minus active extension deficits
What is TPM?
Same as TAM BUUUT passive flexion/extension measurements used
Normal TAM value
220-240
Normal TPM measurements
240-260
Normal Index MCP AROM/PROM
0-70, 0-80
Normal Index PIP AROM/PROM
20-50, 10-70
Normal Index DIP AROM/PROM
20-50, 10-55
Thumb abduction AKA
Radial abduction
MP Capsular Pattern
More restriction in flexion than extension
IP capsular pattern
More restriction in extension than flexion
Wrist capsular pattern
Equal loss of DF and flexion
CMC capsular pattern
Abduction and extension limited…flexion relatively free
Middle finger normal mcp arom/prom
0-90, 0-90
Middle finger PIP arom/prom
50-100, 45-110
Middle finger DIP arom/prom
0-70, 0-70
What is volar surface?
Palm of hand
Passive restriction to extension?
Volar plate adhesions, volar skin contracture, bony block, flexion tendon adhesion
Passive restriction to flexion indicative of
Dorsal skin tightness, extensor tendon scar/tightness
Active restraint to extension indicative of
Passive restraint/extensor lag
Active restraint to flexion indicitive of
Passive restraints or flexor tendon rupture/adhesion
What can cause active restraint to flexion?
Some sort of. Trauma
Limited composite passive flexion-pattern:
Extensor tendon tightness, dorsal skin tightness
Limited composite active flexion with normal composite passive flexion-pattern
Flexor tendon adhesion or rupture
Oblique Retinacular Ligament Tightness test
- DIP Passively flexed with PIP in extension, then flexion
- Greater motion with PIP flexion: ligament contracture
- If DIP joint bends easily with PIP joint flexed but not when extended, then tight/contracted ligament (if DIP is tight in both, then probably a capsular problem)
Intrinsic Tightness Test
- Intrinsics on passive stretch (MP extension and IP flexion), then relaxed via MP flexion
- If PIP can be passively flexed more with MP joint in flexion than extension = positive test for tightness
Partial range = 2 for which MMTs
Finger abduction/adduction, APL, opposition
How to perform dynamometer testing?
- Pt sitting, shoulder adducted at side, elbow flexed 90, wrist in 0-30 extension/ 0-15 ulnar deviation
- Adjust one of five handle position
- Perform one squeeze each position/three squeezes in one position–average readings
- Alternate R/L to avoid fatigue
Phalen’s test
The swan test for carpel tunnel where you sit there for one minute–pos for parathesias
***median nerve
Tinel’s sign
Tap over carpal tunnel–positive ulnar nerve impingement if. Parathesias
Froment’s sign
- APL/B weakness vs ulnar nerve paralysis
- Grasp paper between them/radial side of index finger
- Positive sign = terminal phalanx flexes or mcp hyperextends
Finkelstein’s Test (probably not that good)
- Tenosynovitis of AbPL/EPB
- **deQuervian’s disease
- fist while holding thumb inside and ulnar deviate
- positive = pain in area of tendons
What is more commonly used– static grip testing or rapid exchange testing?
Static grip (usually 3 x each side instead of switching hands back and forth quickly)
