Hand examination

Question 1

What are the introductory steps for a hand examination?

Answer 1

• Wash hands.
• PPE.
• Introduce self.
• Patient name and DOB.
• Explain examination.
• Obtain consent.

SPECIFICALLLY FOR HAND EXAMINATION:
- Ask if the patient has any pain/tingling in hands.

Question 2

What comes after introduction?

Answer 2

Inspection (LOOK).

Question 3

What should be looked for during inspection?

Answer 3

• Nail abnormalities (e.g. pitting, clubbing, spooning etc.)
• Dorsum (Skin, scars, muscle wasting, deformities).
• Wrists (Swelling?).
• Palmar surface (Skin, scars, muscle wasting, deformities).
• REMEMBER TO INSPECT THE ELBOWS.

Question 4

What comes after inspection?

Answer 4

Palpation (FEEL).

Question 5

How is palpation carried out?

Answer 5

First, ask about pain. Also ask the patient to say if any of the following palpations hurt.

• Palpate the wrist.
• MCPJ Squeeze.
• Palpate each joint of the fingers individually, thumbs on top and other fingers in the palm.
• Palpate the anatomical snuffbox.
• Palpate the palm for thickening.
• Check sensation in the hands (palmar pinky, palmar ring finger, palmar thumb, dorsal aspect of hand).
• Check ulnar and radial pulse.
• Allens test (tight fist, apply pressure, release fist, release pressure).

Question 6

What comes after palpation?

Answer 6

MOVE.

Question 7

What order should move be carried out in?

Answer 7

• Active movement first, then passive if there is a limited range of motion.

TAKE CARE NOT TO CAUSE EXCESSIVE DISCOMFORT.

Question 8

How is MOVE tested?

Answer 8

Fingers:
- Make a fist (flexion) then straighten the fingers (extension).
- Spread their fingers (abduction) then back to normal (adduction).

Thumb:
- Point to the celling (abduction) then back (adduction).
- Across the palm (flexion) then out to the side (extension).
- Touch each finger with the thumb (opposition).

Wrist:
- Prayer (dorsiflexion) and reverse prayer (plantar-flexion) positions.
- Chunkz movement (Ulnar and radial deviation).

IF THERE IS ANY REDUCED ROM CAREFULLY TEST THE MOVEMENT PASSIVELY.

Question 9

What comes after MOVE?

Answer 9

Function test.

Question 10

What are the functional tests?

Answer 10

• Squeeze my fingers as hard as you can (power).
• Pinch grip (ask patient to hold a pen, key etc.)
• Precision (can the patient do/undo buttons).

Question 11

What comes after functional tests?

Answer 11

Special tests.

Question 12

What are the special tests for carpal tunnel?

Answer 12

Motor and sensation:
- Test sensation in the median nerve area (palmar thumb).
- Ask patient to supinate their palm and then extend their thumb upwards against resistance.

Tinel’s test:
- Tap strongly over the carpal tunnel.

Phalen’s test:
- Ask the patient to hold hands in reverse prayer for one minute.

Compression test:
- Direct pressure over the carpal tunnel.

Question 13

What special tests are used for the ulnar nerve?

Answer 13

Motor and sensation:
- Test sensation in the ulnar nerve area (palmar pinky).
- Ask patient to cross their fingers (index and middle).
- Ask patient to abduct fingers against resistance.
- Ask patient to hold a piece of paper between thumb and fist while you try to pull it away. If thumb bends, +ve.

Question 14

What special tests are used for the radial nerve?

Answer 14

Motor and sensation:
- Anatomical snuffbox sensation.
- Ask patient to dorsiflex wrist against resistance.

Question 15

What comes after special tests?

Answer 15

• Thank the patient for their time.
• Wash hands.