Hand Exam - Hanel

Question 1

What are the grades of strength

Answer 1

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

Question 2

What do active and passive ROM tell you about the patient

Answer 2

active - patients own muscles work, identifies tendon continuity, nerve function, muscle strength
passive - examiner is moving the patient, identifies joint stiffness, soft tissue contraction

Question 3

describe the angles of ROM of the MCP, PIP, DIP

Answer 3

MCP - 85 degrees flexion (ext 0 for all)
PIP - 110 degrees of flexion
DIP - 65 degrees of flexion

Question 4

How do you test FPL? OINA?

Answer 4

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

Question 5

How do you test FCU?
OINA?

Answer 5

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

Question 6

FCR OINA

Answer 6

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

Question 7

What are the contents of the extensor compartments

Answer 7

1 - APL, EPB

2 - ECRB, ECRL

3. • EPL

4 - EIP, EDC

5 - EDM

6 - ECU

Question 8

How do you test the second extensor compartment?

Answer 8

ECRL & ECRB

Have patient make a fist and extend wrist backwards

Question 9

how do you test the 3rd dorsal compartment

Answer 9

EPL

Have patient hyperextend thumb while holding hand flat on table

Question 10

How do you test the 1st extensor compartment

OINA?

Answer 10

APL, EPB

Have patient “bring thumb out to your side”

APL

Question 11

What is the OINA of the ineterossei

Answer 11

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

Question 12

Lumbricals OINA

Answer 12

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

Question 13

Radial nerve test

Answer 13

Test thumb IP joint extension

Question 14

Median nerve test (fxn)

Answer 14

Recurrent motor branch: palmar abduction of the thumb

AIN: flexion of the thumb IP joint an index DIP (a-OK sign)

Question 15

testing ulnar nerve function

Answer 15

crossing fingers (tests interossei)

Question 16

sensibility test for raidal, median, ulnar, digital nerves

Answer 16

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)

Question 17

describe the grind test

Answer 17

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

Question 18

Fingkelsteins test

Answer 18

for dequervains tendonitis

make a fist overlying thumb and ulnarly deviate wrist, positive if painful. Pathology in 1st extensor compartment

Question 19

Bunnells test

Answer 19

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

Question 20

scaphoid stability test (Watson test)

Answer 20

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

Question 21

LT shear (shuck test)

Answer 21

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

Question 22

mid carpal instability test

Answer 22

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

Question 23

ulnar abutment test

Answer 23

tests for TFCC tear or ulnar-carpal impingement

examinar ulnarly deviates the patients wrist, positive if ulnar deviation produces pain or pop/click

Question 24

Froments sign

Answer 24

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

Question 25

Jeannes sign

Answer 25

tests for ulnar motor nerve weakness

Patient attempts key pinch, if their MCP hyperextends they likely have ulnar n injury

Question 26

wartenbergs sign

Answer 26

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