Hand Examination by l467Q1b


									                              HAND EXAMINATION
   - 1) Elbows: nodules, scars, psoriatic lesions, inflammatory signs
   - 2) Hands (both, on pillow, dorsum):
         o DORSUM
                 1) skin: atrophy, purpura, nodules, rashes, scars
                 2) nails: onycholysis, vasculitis-evidence (splinter haemorrhages)
                 3) soft tissue: nodules, swelling over joints, muscle wasting (dorsal interossei)
                 4) bones:
                        1) Wrist (subluxation, ulnar deviations),
                        2) MCP (subluxation, ulnar deviation)
                        3) Digit (Boutonniere, Swanneck), thumb
         o PALMAR
                 1) Thenar eminence bulk

  - WRIST, MCP (squeeze!), PIP
  - 1) Temperature (above + below) MCP-joints
  - 2) Swelling  squeeze joint (fluctuant)
        o compare with joint of opposite limb
  - 3) Tenderness (look at patient)

   - 1) Active
         o wrist: extend + flexion (hide your nails)
         o Pronation/supination: turn hands over
         o Still wrist, extend little finger
         o PRAY: put fingers flat together
   - 2) Passive
         o extension + flexion
   - 3) Resisting
         o extension + flexion

FUNCTION (as sometimes impaired movement but good function, both hands)
  - 1) Pinch grip  try to undo it
  - 2) Hook  try to straighten it
  - 3) Paper (thumb over it)  try to pull paper
  - 4) Squeeze fingers (power grip, put my 2 fingers into her fist)

   1) Sensation:
         a. MEDIAN: along 2nd finger (C6)
         b. ULNAR: little finger (C8)
         c. RADIAL: 1st interosseus
         d. Test for diabetic neuropathy (glove): along dorsum of hand up forearm, ask if feeling
         e. Dorsum surface
   2) Motor:
         a. ULNAR: Dorsum, spread fingers out  try to push fingers back together (ulnar
             innervated movement)
         b. MEDIAN: Palm, thumb abduction (pushing down, assessing power of abductor pollicis
             brevis, median nerve innervated movement)
         c. RADIAL: Fist, dorsum  try pushing wrist down (radial nerve innervated movement)
        o If limited active + passive movements  problem within joint
        o If limited active movement only (passive movement being normal)  problem outside
           joint, e.g. tendon
                outside the joint  bone, nerve, tendon, ligaments, skin, referred pain
                         Mallet finger – loss of extensor tendon continuity at DIP-joint, causing
                            the joint to rest in an abnormally flexed position

                           Swan neck

                           Boutonniere

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