Hand Exam

June 01, 2016 Print Friendly Version of this page Print Get a PDF version of this webpage PDF
Introduces self
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Confirms name & age of patient
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Explains & gains consent
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Asks if patient suffers from pain, stiffness or reduced range of movement in the hands
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Washes hands
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Exposes patient’s hands and the joints above (elbows) and asks them to stand
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General inspection around bed and patient (walking aids, obvious scars, wasting or deformities)
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Gross inspection for deformities (dupuytren’s contracture/ulnar deviation/swan-neck/Boutonniere/Z-thumb), amputations or palmar erythema
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Closer inspection for wasting (thenar and hypothenar eminences), scars, thinning or tightening of skin
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Inspects nails for pitting, onycholysis, splinter haemorrhages or fold infarcts
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Inspects joints for nodules (Hebedrens/Bouchard/tophi), wasting, scars or erythema
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Inspects and feels elbows for nodules, tophi or psoriatic rash
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Feels temperature
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Feels each joint (MCP, PIP and DIP) for tenderness and checks for effusion
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Performs the MCP squeeze looking for pain
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Palpates deep in the anatomical snuff box
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Asks patient to form prayer sign
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Asks patient to form reverse prayer sign. Holds reverse prayer sign for 30 seconds to elicit carpal tunnel syndrome (positive Phalen’s)
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Checks range of movement in wrist
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Asks patient to make a fist and then release and straighten out
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Tests grip strength
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Asks patient to quickly tap the ipsilateral thumb with each finger to test opposition
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Tests function e.g. writing, do up a button
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Tests radial nerve motor function by asking patient to extend wrist against resistance
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Tests ulnar nerve motor function by testing finger abduction and adduction
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Tests median nerve motor function by asking patient to form a pincer grip between thumb and index. If thumb is flexed, Froment’s sign is positive (ulnar nerve injury). Tests the strength of the grip
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Tests radial sensory component on dorsum of thumb
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Tests ulnar sensory component on lateral palm or digit 5
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Tests median sensory component on palmar thumb surface
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Offers to perform Tinel’s test for carpal tunnel syndrome
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Offers examination of entire upper limb, full neurovascular exam and history
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Thanks patient
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Washes hands
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Offers next step (imaging: 2 plain x rays for bony pathology or CT if indicated, MRI for soft tissue)
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Summarises appropriately with only key findings
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Offers appropriate differential diagnoses
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