Hand Examination

Question 1

Look - Findings:

WADES mneumonic is used. What does it stand for?

Answer 1

Wasting
Asymmetry 
Deformities 
Erythema 
Scars/swellings

Question 2

Look - Findings:

What 3 things are you looking for when you are looking at the ulnar border of the forearm?

What 2 nail changes are present in psoriasis?

OA:

• What happens to the carpometacarpal (CMC) joint?
• What are the 2 nodes that form and where do they form?

RA:

• How can you tell there is muscle wasting?
• Carpal tunner syndrome can occur due to RA. Where will it cause muscle wasting?
• Ulnar nerve entrapment can also result from RA. Where will it cause muscle wasting?
• What 4 deformities will you find in RA?

Answer 2

Rheumatoid nodules
Psoriatic plaques
Tophi - gout

Onycholysis
Pitting of the nail

CMC squaring - look up

Heberden nodes - DIP
Bouchard nodes - PIP

Visible dorsal tendons

Thenar wasting

Hypothenar - opposite side of hand

Swan neck or Boutonniere
Ulnar deviation
Z thumb

Question 3

Look - Findings:

Hand deformities:

• What joints are flexed and hyperextended in a swan neck deformity?
• What joint is flexed in Boutonniere deformity?
• What joint is completely flexed in a mallet deformity?

Answer 3

Hyperextended - PIP
Flexed - DIP

PIP

DIP

Question 4

Feel - Findings:

What 4 things do you feel for when the palms are down?

Are hands up or down?

Answer 4

Radial pulse - on both - can also feel TEMP
Thenar and hypothenar eminences
Tendon thickening
Sensation

Hands up - palms up

Question 5

Feel - Findings:

HANDs
Sensation:
- Where do you feel to test the median nerve?
- Where do you feel to test the ulnar nerve?

TURN HAND OVER!

• When you turn the hands over, where do you test for the radial nerve?

Why do you do an MCQ squeeze?

Then you palpate the joints!

What should you not forget to do when palpating?

Answer 5

Thenar eminence

Hypothenar eminence

First web space between thumb and index

Looking for tenderness

Looing at face for a response

Question 6

Move - Findings:

What does lack of extension suggest?

What nerve does finger abduction?

Thumb abduction - what nerve is responsible?

What nerve is responsible for wrist extension?

What nerve is responsible for making a fist?

Answer 6

Radial nerve injury

Ulnar nerve

Median nerve

Radial nerve

Median nerve

Question 7

Function - findings:

What 3 things do you ask them to do?

Answer 7

Grip strength

Pincer grip

Pick small object

Question 8

Function - findings:

Pincer grip - what nerve is responsible for this?

What never is responsible for grip?

Answer 8

The median nerve

Median nerve

Question 9

Special tests:

What test do you get them to do and why?

Answer 9

Phalen’s test for 60 seconds

Carpal tunner syndrome