Hand Examination Flashcards
Introduction?
- wash hands
- introduce yourself to the patient
- confirm patient details
- explain the procedure
- gain consent
Inspect hands?
Back hand
1. scars and swelling
2. deformities
3. skin and nail changes
4. muscle wasting
Turn hand over
5. Dupuytrens contracture
6. thenar and hypothenar wasting
Inspection of elbows?
- psoriatic plaques
- rheumatoid nodules
Feel?
Ask if there is pain in fingers
1. assess and compare temperature (palm side)
2. palpate radial and ulnar pulses
3. assess thenar and hypothenar muscle bulk
4. assess for palmar thickening
- Dupuytrens contracture
5. assess sensation of hands
- media
- ulnar
- radial nerve
6. assess and compare joint temperature (back hand side)
7. squeeze metacarpophalangeal joints
- observe for signs of discomfort
8. bimanually palpate the joints of the hand
- note any tenderness and asymmetry
9. palpate anatomical snuff box
- tenderness may suggest scaphoid fracture
10. palpate the ulnar border of each arm to the elbow
- note any rheumatoid nodules or psoriatic plaques
Where do you test sensation of nerves of the hand?
palm side
1. median nerve (C5 - C8)
- thumb, index, middle and half of ring fingers
2. ulnar nerve (C8 -
- pink finger and half of ring finger
backside
3. radial nerve (C6-C8)
- back of thumb
Name the joints tested on feel?
- interphalangeal articulations of hand
- hinge joints between the finger bones - metacarpophalangeal joints
- where fingers meet the palm - intercarpal articulations
- where palm meets the wrist - wrist
What is tested on move?
- finger extension and flexion
- make a fist - wrist extension
- put hands together (prayer)
- normal ROM = 90 degrees - wrist flexion
- put hands back to back
- normal ROM =90 degrees - passive wrist flexion and extension
- move hand up and down at wrist
- feel for crepitus - finger extension against resistance
- hands raised and you try to push them down with the side of your hand
- radial nerve - finger abduction against resistance
- fingers spread and you try to push them together
- ulnar nerve - thumb abduction against resistance
- point thumb to ceiling
- median nerve
What do you test on function?
- power grip
- squeeze my fingers tightly - pincer grip
- squeeze my finger with your thumb and index fingers - observe the patient picking up a small object
- both hands
Special tests?
- Tinels test
- Phalens test
What is the Tinel sign?
the tingling or prickling sensation elicited by the percussion of an injured nerve trunk at or distal to the site of the lesion
- the sign also indicates nerve regeneration
Positive Tinels test?
a tingling or prickling sensation is felt in the distribution of the nerve
Conditions associated with a positive Tinels sign?
- Carpal tunnel syndrome
- cubital tunnel syndrome
- radial nerve entrapment
- tarsal tunnel syndrome
- thoracic outlet syndrome
What is the Phalens test?
a test for carpal tunnel syndrome
Describe the Phalens test?
the patient flexes their wrists by pressing their hands together back to back and holds that position for 60 seconds
Positive Phalens test?
buring, tingling and numbness in the distribution of the median nerve
- this position will increase the pressure in the carpal tunnel in effect compressing the median nerve between the transverse carpal ligament and the anterior border of the distal end of the radius
