hand examination in primary care
TRANSCRIPT
Hand examination in primary care
Ian GrantConsultant Plastic Surgeon
Addenbrooke’s Hospital Cambridge
2010
ExaminationBegins when the patient enters the room
Examination: sequence
LookFeelMoveProvokeQuantify
Look
Surface anatomy Posture: cascade Deformity, swelling, skin quality
Ulnar nerve palsy – first web wasting, small and ring finger MCP hyperextension, PIP joint flexion
Thenar wasting
Carpal tunnel syndrome
Posture: Boutonnière deformity – central slip avulsion - division
IGIGIG
IG IG IG
Posture: extended digitFDP avulsion ring finger - rugby shorts
IGIGIG
Posture: extended digitFDP rupture - bricklayer
IGIGIG
IG
IG
Deformity:Dupuytren’s disease(cords, pits, nodules)
Rheumatoid arthritis - posture / deformity
Thumb OA – posture, CMC subluxation
Palpate
Skin quality and temperature
Tenderness: radial to ulnar, proximal to distal, dorsal then volar
Leave likely tender areas to last
Move: active then passive
Wrist Flex70
Radial 15
Pronation85
Extend50
Ulnar 30
Supination85
Move
Fingers
Joint MotionMCPJ 0-90º
PIPJ 0-110ºPIPJ 0-70ºTotal 270º
Neurological examination
Sensibility Sensation: static 2 point discrimination Ten test – compare 2 sides 10/10 –
light moving touch
Grip and strength
Muscle grade MRC 0-5 0= no contraction 1= Trace of contraction 2= Muscle contraction but not against gravity 3= Move limb against gravity 4= good but not normal 5= Normal
Grips
Power (all 4 fingers) Pinch (tip to tip) Key (thumb pulp) Tripod (three fingers) Karapandji - opposition
testing (the patient touched the tip of the thumb to the index, middle, ring and small finger tips -
Vascular
Capillary refill Allen’s test
Bone / Joints
Swelling, deformity, loss of motion Gamekeeper’s / Skier’s thumb Mallet finger Scaphoid fracture vs Scapho-lunate
ligament rupture
Provocation tests
DeQuervains: Finkelstein’s test
Phalen’s
Tinel’s
Watson’s test, pivot shift test, scapholunate ballotment test, Reagan’s test for luno-triquetral instability
CMC joint pressure/Radial and ulnar deviation