Hand examination

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  1. Ulna nerve sensory function
    Dorsum and palm of little finger and ulna border of ring finger
  2. Median nerve sensory function
    • Palmar- thumb, index, middle and radial border of ring finger
    • Dorsal - distal phalanx of thumb, index, middle and ring finger radial border
  3. Radial nerve sensory function
    First web space of dorsum aspect
  4. Ulnar nerve motor function
    • Abduction - fanning
    • Crossing fingers
    • Adduction of thumb
  5. Median nerve motor function
    • Abduction of thumb
    • Opposition of thumb
  6. Radial nerve motor function
    Dorsiflexion against resistance
  7. What is the 3 nerve test?
    • Kumars 'ok'
    • Dorsiflexion
    • Fanning
    • Opposition
  8. What does altered sensation distal to an injury indicate?
    Nerve damage
  9. What is associated with a high index of suspicion for nerve damage?
    • Tendon injury
    • Spurting digital vessels
    • Location of wounds
  10. How are digital nerves tested?
    • Light touch
    • Blunt sharp
    • 2 point discrimination
    • Sweating
  11. What does lack of sweating indicate?
    Nerve damage
  12. After injury, how long may digital nerves continue to function?
    • Up to 2 days post injury
    • May need review in clinic
  13. Muscles of the hand
    • Thenar
    • Hypothenar
    • Intra osseous / lumbricals
  14. Joints of the hand
    • DIPJ
    • PIPJ
    • MCPJ
    • IPJ- thumb
  15. Action of the thenar muscle
    Thumb opposition
  16. Action of the hypothenar muscle
    Supplies the little finger
  17. Action of the intra osseous and lumbricals
    • Acts on fingers
    • Flexion at the MCPJ
    • extends IP joints
    • Adductsfingers
  18. Flexor tendons of the hand
    • Flexor digitorum superficialis (FDS)
    • Flexor digitiorum profundis (FDP)
  19. Action of flexor digitiorum superficialis (FDS), short
    • Attaches to base of middle phalanx
    • Flexes PIPJ
  20. Action of the flexor digitiorum profundis (FDP), long
    • Attaches to base of distal phalanx
    • Flexes DIPJ
  21. How to test FDS, short
    • place hand palm up
    • Isolate 3 fingers
    • Ask patient to curl the non isolated finger
  22. How to test the FDP, long
    • Hold hand palm up
    • Press proximal part of middle phalanx
    • Ask patient to bend at DIPJ
  23. Extensor tendons of the hand
    • Extensor digitiorum - lateral slip
    • Extensor digitiorum - central slip
    • Extensor digitiorum - terminal slip
  24. Action of the extensor digitiorum lateral slip
    • Passes around the PIPJ, inserts at the base of distal phalanx
    • Extends PIPJ and DIPJ
  25. How to test ext digitiorum lateral slip
    • Hold hand flat on table
    • Ask patient to extend each finger
    • Press on proximal phalanx to apply resistance
  26. Action of the extensor digitiorum central slip
    • Inserts at the base of the middle phalanx
    • Extends PIPJ
  27. How to test extensor digitiorum central slip
    • Place hand over edge of table
    • Middle and distal phalanx over the edge
    • Apply pressure to middle phalanx and ask patient to straighten
  28. Action of the the extensor digitiorum terminal slip
    Extension of DIPJ
  29. What injury is caused by damage to the ext dig, terminal slip
    Mallet finger
  30. Action of the collateral ligaments
    Splint fingers over the ulnar and radial border
  31. How to test the collateral ligaments
    • Fingers slightly flexed
    • Stress test laterally between finger and thumb
  32. Movements of the thumb
    • Flexion
    • Extension
    • Adduction
    • Abduction
    • Opposition
  33. Tendons of the thumb
    • Flexor pollicis longus FPL
    • Extensor pollicis longus ( EPL)
    • Extensor pollicis brevis (EPB)
    • Abductor pollicis longus (APL)
    • Ulnar collateral ligaments
    • Collateral ligaments
  34. Action of the FPL
    Flexion of the thumb at the IPJ
  35. How to test FPL
    Flexion of IPJ with proximal phalanx fixed
  36. Action of the EPL
    • Extends thumb at all joints
    • Inserts at the base of the distal phalanx
  37. How to test the EPL
    • Hand flat on the table
    • Ask to lift thumb
  38. Where is the EPL visible and palpable
    • With thumb extended
    • Tendon at base of the thumb, ulnar border
  39. Action of the EPB
    • Inserts at the base of the proximal phalanx
    • Extends thumb at MCPJ
  40. How to test EPB
    • With thumb extended and abducted
    • Press thumb towards hand at proximal phalanx
  41. Where is the EPB palpable and visible
    • Thumb extended and abducted
    • Middle tendon at base of thumb
  42. Action of APL
    Abduction of the thumb
  43. How to test the APL
    Ask to abduct the thumb
  44. Where is the APL visible and palpable
    • Thumb extended and abducted
    • Tendon at base of thumb most radially
  45. When should the ulnar collateral ligament be tested
    Injury to the thumb
  46. How may the ulnar collateral ligament be damaged
    • Violent radial abduction of the thumb
    • Skiing
    • Game keepers thumb
  47. What is the action of the UCL
    Prevents abnormal opening of the MCPJ of the thumb in the ulnar side
  48. What occurs if the UCL is stretched or torn
    MCPJ of thumb is unstable
  49. How to test UCL
    • Stress the ligament
    • Radially abduct the thumb
  50. What indicates a complete rupture of the UCL
    Marked laxity and no pain on stressing
  51. How to assess circulation
    • CRT
    • radial and ulnar pulses
    • ALLENS test
  52. How to do the ALLENS test
    • Occlude radial and ulnar arteries
    • Get patient to squeeze hand a few times
    • Release one artery, look for pinking of hand
    • Repeat on other artery
  53. Anatomical land marks of the hand
    • Wrist
    • Scaphoid - ASB, tubercle, axial compression
    • Each metacarpal
    • Each finger
    • Radial pulse
    • Radial, ulnar and median nerves
  54. Things to look for on hand
    • Bruising, swelling, deformity, wounds
    • Cascade
    • Rotational deformity
  55. What can be seen from assessing hand cascade
    • Some tendon injuries
    • Deformities
    • Rotation
    • Loss of knuckle definition
    • Dislocation
    • Angulation
  56. How to assess movement of hand
    • Make a fist
    • Look for rotational deformity, scissoring of little finger
    • FDS
    • FDP
    • EXT
    • C.SLIP
  57. How to assess movement of thumb
    • Abduction
    • Adduction
    • Flexion
    • Extension
    • Opposition
  58. Important hand history
    • Mechanism of injury
    • Hand dominance
    • Occupation and hobbies
    • Symptoms
    • Progression
Card Set
Hand examination
Hand examination
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