PE

Question 1

Hand examination- Wrist Cut

Answer 1

1. WIPE: Pillow, painkillers
   2.General Appearance - Distress due to pain
   3.Inspection
   - Dressing
   - Pallor
   - trauma signs (lacerations, redness, bruising, swelling)
   - Deformity-loss of normal flexion of hands
2. Palpation
   -Temperature
   -CRT
   -Pulse
   -Tenderness
3. Movements
   -wrist flexion
   -DIP flexion
   -MCP (deep and superficial flexion)
   -Middle finger flexion (PIP Isolated)
   -thumb flexion
4. Neurological Examination
   MOTOR-
   M-pen
   U-froments
   R-wrist flexion
   SENSORY
   M-index
   U-5th finger
   R- snuff box

Question 2

Hand Examination- Carpal/Cubital Tunnel Syndrome

Tingling and numbness of hands

Answer 2

1. WIPE: Pillow, painkillers
   2.General Appearance - Distress due to pain
   3.Inspection
   -Thenar and hypothenar atrophy/wasting
   - Pallor
   - trauma signs (lacerations, redness, bruising, swelling)
   - Deformity
2. Palpation
   -Temperature
   -CRT
   -Pulse
   -Tenderness (Fingers-MCP-wrist-elbow)
3. Movement - General MSK
   -open and close fist
   -wrist extension and flexion
   -elbow flexion and extension
4. Neurological Examination
   MOTOR-
   M-pen
   U-froments
   R-wrist flexion
   SENSORY
   M-index
   U-5th finger
   R- snuff box
5. Special tests for carpal tunnel
   * Phalen’s Test
   *Tinel’s Tets
6. Special Test for Cubital Tunnel
   *tap- medial groove
   *Ulnar hypersensitivity test- press and rub medial groove side to side
   *Elbow flexion compression test- elbow in full flexion
   Mention Spurling’s test

Differential Diagnosis
1. Carpal Tunnel Sx
2.Cubital Tunnel Sx
3.Cervical Radiculopathy
4. Sensory Neuropathy (alcohol, DM, Vit B12)
5. Hypocalcemia (post thyroidectomy)
6. Uremia
7. Hypothyroidism

Question 3

Claw hand (full or partial)