Hand & Wrist Examination

Question 1

State the 9 stages of hand & wrist examinatio

Answer 1

1. Introduction
2. General inspection
3. Closer inspection
4. Feel
5. Movement: active & passive
6. Motor assessment
7. Function assessment
8. Special test
9. Completing the examination

Question 2

What should you do in the introduction stage of your hand & wrist examination?

Answer 2

• Wash hands
• Introduce yourself
• Gain consent
• Ask if if any pain
• Position
• Expose

Question 3

What should you do in the general inspection part of your hand and wrist examination?

Answer 3

• General inspection pt:
  
  • Muscle wasting
  • Scars
• Inspection around bed
  
  • Splints
  • Medications

Question 4

What should you do in the closer inspection part of your hand & wrist examination?

Answer 4

Check dorsum of hand

• Posture/deviation (e.g. ulnar secondary to RA)
• Scars
• Swelling
• Skin colour
• Bouchards nodes
• Herbenden’s nodes
• Swan neck deformity
• Boutonniere’s
• Z thumb
• Psoriatic plaques
• Nail pitting & onycholysis

Palmar aspect

• Hand posture
• Scars
• Swelling
• Dupuytren’s contracture
• Thenar or hypothenar wasting

Elbows

• RA nodules
• Psoriatic plaques

Question 5

What should you do in the feel stage of your hand & wrist examination?

Answer 5

With palms up:

• Temperature
• Radial pulse
• Ulnar pulse
• Thenar & hypothenar eminence bulk
• Palmar thickening
• Median & ulnar sensation

With palms down:

• Radial nerve sensation
• MCP joint squeeze
• Bimanual joint palpation:
  
  • MCPJ
  • PIPJ
  • DIPJ
  • CMCJ of thumb
• Anatomical snuffbox
• Bimanual wrist palpation
• Elbow palpation

Question 6

What should you do in the move stage of your hand & wrist examination?

Answer 6

Active movement

• Finger flexion
• Finger extension
• Finger abduction
• Finger adduction
• Wrist extension
• Wrist flexion

Passive movement

• Finger flexion
• Finger extension
• Finger abduction
• Finger adduction
• Wrist extension
• Wrist flexion

Question 7

What should you do in the motor assessment stage of your hand & wrist examination?

Answer 7

• Palm flat on table, lift thumb off table (radial)
• Make an okay sign (median nerve)
• Cross fingers (ulnar nerve)

Question 8

What should you do in the function stage of your hand & wrist examination?

Answer 8

• Power grip: squeeze my fingers with your hands
• Pincer grip: squeeze my finger between your thumb & index finger
• Pick up small object: please pick up this coin

Question 9

What should you do in the special tests stage of your hand & wrist examination?

Answer 9

• Tinel’s test: tap over carpal tunnel and see if carpal tunnel symptoms
• Phalen’s test: ask pt to put dorsal surfaces of hand together and do maximum wrist flexion for 60 seconds- see if any pain. Positive if recreates carpal tunnel symptoms

Question 10

What should you do in the completing your examination stage of your hand & wrist examination?

Answer 10

• Thank pt
• Wash hands
• Summarise findings
• Further assessments & investigations:
  
  • Examine elbow & shoulder joint
  • Full neurovascular examination of upper limb
  • Further imaging if indicated e.g. x-ray