Hand Examination

Question 1

General inspection

Answer 1

Pain, walking aids, medications etc

Question 2

Look: Palms down

Answer 2

Posture, scars, swelling
Skin changes 
Deformities 
Muscle wasting 
Nail changes - nailfold vasculitis? psoriatic changes?

Question 3

Look: palms up

Answer 3

Posture, swelling
Scars - carpal tunnel?
Skin changes
Deformities - dupuytren’s contracture, ulnar deviation
Muscle wasting - isolated wasting of thenar eminence is suggestive of carpal tunnel syndrome
Elbows - rheumatoid nodules, psoriasis, tophi

Question 4

Feel

Answer 4

Temperature
Thenar and hypothenar eminences, thickening
MCP squeeze, PIPs, DIPs, base of thumb, ulnar border, ulnar head, radial styloid process, along ulnar border to elbow, anatomical snuffbox

Question 5

Move

Answer 5

Function: thumb to fingers, grip strength, coin / button
Fingers: flexion, extension, abduction
Thumb: abduction, adduction, flexion, extension, opposition
Wrist: extension and flexion, pronation and supination

Question 6

Special tests

Answer 6

Phalen’s test (CTS) - fully flex wrist and hold for up to 60s, if symptoms are reproduced (burning, tingling etc) then + (MEDIAN NERVE)

Frontmen’s test (UNP) - paper between flat thumb and index finger and attempt to pull paper out, need for pinch grip to hold paper is +

Question 7

Neurovascular

Answer 7

Power: resisted finger extension (radial), finger abduction (ulnar) and thumb opposition (median)

Sensation: thenar (median), hypothenar (ulnar), 1st dorsal web space (radial)

Radial, ulnar and cap refill

Question 8

Joint above

Answer 8

Wrist range of movements

Question 9

To finish

Answer 9

Wash hands, thank patient

I would also like to….

Question 10

OA

Answer 10

Bouchard’s nodes (PIPs)

Heberden’s nodes (DIPs)

Question 11

RA

Answer 11

Swan neck deformity - DIP hyperflexion and PIP hyperextension

Z- thumb - hyperextension of interphalangeal joint and fixed flexion and subluxation of the MCP joint

Boutonnières deformity - PIP flexion and DIP hyperextension