Hand Exam

Introduces self	0	1
Confirms name & age of patient	0	1
Explains & gains consent	0	1
Asks if patient suffers from pain, stiffness or reduced range of movement in the hands	0	1
Washes hands	0	1
Exposes patient’s hands and the joints above (elbows) and asks them to stand	0	1
General inspection around bed and patient (walking aids, obvious scars, wasting or deformities)	0	1
Gross inspection for deformities (dupuytren’s contracture/ulnar deviation/swan-neck/Boutonniere/Z-thumb), amputations or palmar erythema	0	1
Closer inspection for wasting (thenar and hypothenar eminences), scars, thinning or tightening of skin	0	1
Inspects nails for pitting, onycholysis, splinter haemorrhages or fold infarcts	0	1
Inspects joints for nodules (Hebedrens/Bouchard/tophi), wasting, scars or erythema	0	1
Inspects and feels elbows for nodules, tophi or psoriatic rash	0	1
Feels temperature	0	1
Feels each joint (MCP, PIP and DIP) for tenderness and checks for effusion	0	1
Performs the MCP squeeze looking for pain	0	1
Palpates deep in the anatomical snuff box	0	1
Asks patient to form prayer sign	0	1
Asks patient to form reverse prayer sign. Holds reverse prayer sign for 30 seconds to elicit carpal tunnel syndrome (positive Phalen’s)	0	1	2
Checks range of movement in wrist	0	1
Asks patient to make a fist and then release and straighten out	0	1
Tests grip strength	0	1
Asks patient to quickly tap the ipsilateral thumb with each finger to test opposition	0	1
Tests function e.g. writing, do up a button	0	1
Tests radial nerve motor function by asking patient to extend wrist against resistance	0	1
Tests ulnar nerve motor function by testing finger abduction and adduction	0	1
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	0	1
Tests radial sensory component on dorsum of thumb	0	1
Tests ulnar sensory component on lateral palm or digit 5	0	1
Tests median sensory component on palmar thumb surface	0	1
Offers to perform Tinel’s test for carpal tunnel syndrome	0	1
Offers examination of entire upper limb, full neurovascular exam and history	0	1
Thanks patient	0	1
Washes hands	0	1
Offers next step (imaging: 2 plain x rays for bony pathology or CT if indicated, MRI for soft tissue)	0	1
Summarises appropriately with only key findings	0	1
Offers appropriate differential diagnoses	0	1

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