Hand Examination

Question 1

¥
Introduction

Answer 1

WIPEQQ
Hello, I’m An Nakamura, a 3rd year medical student.
Can I confirm your name and DOB
I’d like to examine your wrist and hands, I’ll look, feel and move the joints.
Will this be ok?

Do you have any questions?
Do you have any pain and stiffness in your upper limbs today?

Question 2

General inspection of surroundings

Answer 2

Hand aids - splints, straps

Prescriptions - analgesia

Question 3

General inspection of patient

• general
• dorsum
• palmar

Answer 3

Deformities
Asymmetry
Wasting - thenar/hypothenar?
Scars - carpal tunnel release surgery
Swelling, erythema - inflammation, infection?

Dorsum
- Bouchards and Heberdens - OA
- Swan neck fingers, Boutonnier deformity, Z thumb, ulnar deviation - RA
- Psoriatic plaques (ext surfaces), enthesitis, dactylitis, onycholysis, pitting nails - PA

Palmar
- Janeway, Osler - infective endo
- Dupuytrens - alcoholic, diabetes

Elbows
-psoriatic plaques, rheumatoid nodules

Question 4

Palpation - palmar, dorsal

-palmar

Answer 4

Temperature
-hot, swollen, tender - SEPTIC, INFLAMMATORY

Radial, ulnar pulse - adequate supply to hand

Thenar, hypothenar bulk

Dupuytrens

Median sensation - thenar
Ulnar sensation - hypothenar
Radial sensation - 1st webspace

Question 5

Palpation - joints

-dorsum

Answer 5

Anatomical snuffbox - tender => scaphoid fracture

MCP squeeze - discomfort => active inflammatory joint disease
Bimanual joint palpation (wrists, CMC, MCP, PIP, DIP)
-tenderness, irregularities, warmth

Elbow palpation along ulnar border - tenderness, rheumatoid nodules, plaques

Question 6

Movement
- active
- passive
- median, ulnar, radial nerve function
- fine motor

Answer 6

Active mv
Finger ext - open hand and splay fingers
Finger flex - make a fist
Wrist ext - put your hands together like you’re praying
Wrist flex - put the backs of your hands together and flex wrists

Passive mv - RROI, discomfort, crepitus
Repeat above movements

Median - point thumbs to ceiling, don’t let me push them down
Ulnar - splay fingers, don’t let me move your 1st finger inwards
Radial - splay fingers, don’t let me move your fingers down

Power grip - squeeze my fingers with your hands
Pincer grip - squeeze my finger between your thumb and 1st finger
Pick up a small object off the table

Question 7

Special median nerve tests

-median nerve

Answer 7

Tinels - tap over carpal tunnel
Phalens - inverse prayer hands

Positive - tingling in thumb and 1st-2nd finger => median nerve compression

Question 8

Further examinations

Answer 8

Hx

Neurovascular exam of upper limb
Examination of shoulder and elbows

Imaging - Xray, MRI