Hand Exam - Hanel Flashcards
What are the grades of strength
Grade 0 - no muscle contractions
Grade 1 - faintly palpable fibrillations or contractions
Grade 2 - unable to contract against gravity but able to contract
Grade 3 - able to contract against gravity
Grade 4 - decreased strength to resistance
Grade 5 - normal
What do active and passive ROM tell you about the patient
active - patients own muscles work, identifies tendon continuity, nerve function, muscle strength
passive - examiner is moving the patient, identifies joint stiffness, soft tissue contraction
describe the angles of ROM of the MCP, PIP, DIP
MCP - 85 degrees flexion (ext 0 for all)
PIP - 110 degrees of flexion
DIP - 65 degrees of flexion
How do you test FPL? OINA?
Have patient flex DIP of thumb
O - anterior surface of radius and interosseous membrane
I - base of distal phalanx of thumb
N - AIN
A - flexes MCP and IP joint of thumb
How do you test FCU?
OINA?
Have patient dorsiflex hand
O - Common flexor tendon from medial border of olecranon & upper 2/3 of posterior border of ulna/interosseous membrane
I - Pisiform, hook of hamate, base of 5th MCP
N - ulnar n.
A - flexes wrist, adducts hand
FCR OINA
Test by having patient volar flex wrist
O - Common flexor tendon from the medial epicondyle of the humerus
I - base of the 2nd and 3rd metacarpals
N - median n
A - works with ECRL and ECRB to abduct the hand
What are the contents of the extensor compartments
1 - APL, EPB
2 - ECRB, ECRL
- EPL
4 - EIP, EDC
5 - EDM
6 - ECU
How do you test the second extensor compartment?
ECRL & ECRB
Have patient make a fist and extend wrist backwards
how do you test the 3rd dorsal compartment
EPL
Have patient hyperextend thumb while holding hand flat on table
How do you test the 1st extensor compartment
OINA?
APL, EPB
Have patient “bring thumb out to your side”
APL
What is the OINA of the ineterossei
A - Flex the MCP and extend the IP
Palmar adduction the fingers, dorsal abduct the fingers
O - base of the proximal phalanx and extensor expansion of on the lateral and medial side of the digits
N - radial two lumbricals innervated by median nerve, the rest by ulnar
Lumbricals OINA
O - FDP tendons of digits 2-5
I - extensor expansion on radial side of proximal phalanx of digits 2-5
N - medial two ulnar, radial two median
A - flexes the MCPs, extends the IPs
Radial nerve test
Test thumb IP joint extension
Median nerve test (fxn)
Recurrent motor branch: palmar abduction of the thumb
AIN: flexion of the thumb IP joint an index DIP (a-OK sign)
testing ulnar nerve function
crossing fingers (tests interossei)
sensibility test for raidal, median, ulnar, digital nerves
radial - dorsal thumb-index web space
median - palmar aspect of little finger
ulnar - palmar aspect of little finger
digital - ulnar and radial spect of each fingertip (palmar)
describe the grind test
Used for CMC joint pathology
axial load is applied to pts thumb metacarpal and rotation is applied to grind it, if painful likely CMC arthritis
Fingkelsteins test
for dequervains tendonitis
make a fist overlying thumb and ulnarly deviate wrist, positive if painful. Pathology in 1st extensor compartment
Bunnells test
Tests intrinsic muscle tightness
passively flex the PIP joint once with MCP in extension and one with MCPs held in flexion . If the PIP can be flexed easily when MCPs are flexed but not when extended then there is intrinsic tightness
scaphoid stability test (Watson test)
tests for scaphoid lunate ligament tear
examiner places thumb on pts scaphoid distal pole on palmar side of wrist and the examiner radially and ulnarly deviates the wrist. with radial deviation it should feel more palmar. If it doesn’t change with radial deviation suspect scapholunate ligament disruption
LT shear (shuck test)
tests for lunatotriquetral ligament tear
while holding the lunate between the index and thumb the examiner tries to push the triquetrum dorsally with the other hand
mid carpal instability test
examiner stabilizes the distal radius and ulna with non dominant hand and moves hand from radial deviation to ulnar deviation. If theres a clunk its positive
ulnar abutment test
tests for TFCC tear or ulnar-carpal impingement
examinar ulnarly deviates the patients wrist, positive if ulnar deviation produces pain or pop/click
Froments sign
ulnar nerve motor weakness test
patient holds a piece of paper between thumb and radial side of index, if patient flexes the thumb IP joint to try and hold on to it they are using median supplied nerve to compensate
Jeannes sign
tests for ulnar motor nerve weakness
Patient attempts key pinch, if their MCP hyperextends they likely have ulnar n injury
wartenbergs sign
tests for ulnar nerve motor weakness
pt is asked to hold their fingers fully adducted with MCP, PIP, DIP joints fully extended
positive if small finger drifts away into abduction (due to 3rd palmar interosseous muscle weakness) and the insertion of the EDM which has ulnar deviation vector
