Hand examination Flashcards
Why are hand examinations iportant?
IN OSCE might need to refer to hand surgeon. diabetes trauma other things
What side are the flexor tendons on?
The palmar side
Why is the anatomical srufbox inportant clinically?
Radial artery palpation and scaphoid fracture
What inervates the extensors in the arm?
radial nerves
What does the ulnar nerve innervate?
Sensation to little finger and half of the next and on the back. it also does intrinsic muscles of the hand hypothenaer thenar and
What does median nerve suppky?
The front of the hand not little and ring also finger flexors ut not ulnar 2 FDP APB
What does radial nerve do?
The back side of the hand wrist extensors finger extensors
What are the first part of hand exam?
Wash hands introduce identify patient consent position patient hand on pillow. ask if they have pain
When might you get hand injuries?
Work leisure
what are important in hand exam?
Age, sex, occupation/hobbies right or left handed PMH drugs allergies.main issue pain loss of function pins and needles Activities of daily living
What are key parts of hand exam?
Look feel move
WHat to look for on hand?
Clubbing , pitting, colour of digits etc skin cancers melanoma dark nail streak squamous cell carcinoma, Scars bruising, colour, what are swellings on hand ganglion synovitis, palm scars skin changes muscle wastingDupytren’s contracture (alcohol).
What can you see in OA?
Bouchards nodes nodules heerdens nodes erosion
What can you see in RA?
Ulnar drift swan neck boutonniere
What to feel in palm?
radial artery puls capillary refil Allen’s test. feel thenar muscle mass. check sensation of nerve areas temperature of hand.
What to check in movement?
Active and passive movement. flexion extension of wrist flex extend fingers apread fingers.
How to test ulnar nerve?
Check finger spreading hold paper down(fromans test)
How to test radial nerve?
Look for wrist drop can they move muscles
How to check function?
Power key pinch grip precision
What happens in carpel tunnel syndrome?
often at night numbnes pain pins and needles clumsiness, radial 3 and 1/2 digits flexion issues
what find in carpal tunnel exam?
Thenar eminence wasting. sensation, APB bad, Phalen’s test backs of hand togethere at 90 degreees, Tinel’s test tapping does it give same pain
What investigations for carpal tunnel investigations?
Nerve conduction studies, Thyroid function tests, routine blood tests
What ais carpel tunnel differential?
Cervical spine spondylosis, cubital tunnel, wrist pain, other problems psychological
What is cubital tunnel syndrome?
ulnar nerve issues
What is treatment of carpal tunnel?
Conservative wrist splint, steroid injection surgery
