Hand exam: Difference between revisions
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*Must exam tendon injuries in their entirety through full range of motion | *Must exam tendon injuries in their entirety through full range of motion | ||
**Injuries w/ digits in flexion may cause retraction of cut end of tendon when examined in neutral position | **Injuries w/ digits in flexion may cause retraction of cut end of tendon when examined in neutral position | ||
*All exams should include a thorough hx of events | |||
==Exam== | ==Exam== | ||
===Inspection=== | |||
*General appearance | |||
*Palpate for: Crepitus, deformity, joint tenderness, rotation deformity, snuffbox tenderness | |||
===Motor=== | ===Motor=== | ||
*Bilateral grip strength | *Bilateral grip strength | ||
*Have pt make a clenched fist | *Have pt make a clenched fist | ||
**Observe orientation and rotation of middle and distal phalanxes | **Observe orientation and rotation of middle and distal phalanxes | ||
**Assess for scissoring (overlapping of digits) | |||
**All phalanges should be oriented parallel to each other w/ nails in same plane | **All phalanges should be oriented parallel to each other w/ nails in same plane | ||
*Have pt draw fingertips together so tip of thumb touches tips of the other 4 digits | *Have pt draw fingertips together so tip of thumb touches tips of the other 4 digits | ||
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*Pincer function test | *Pincer function test | ||
**Weakness suggests median nerve or ulnar collateral ligament disruption | **Weakness suggests median nerve or ulnar collateral ligament disruption | ||
===Tendons=== | |||
*Must test with resistance | |||
*Pain along course of tendon during resistance testing suggests partial rupture | |||
*Flexor digitorum profundus (FDP) | |||
**Flex DIP against resistance while MCP and PIP joints are held in extension | |||
*Flexor digitorum superficialis (FDS) + Flexor pollicis longus (FPL) | |||
**Flex PIP against resistance while remaining fingers are held in extension | |||
*Extensor tendons | |||
**Hand flat an surface and lift fingers individually | |||
===Circulation=== | ===Circulation=== | ||
*Assess via cap refill and radial pulse | *Assess via cap refill and radial pulse | ||
*Allen test | |||
===Nerve Testing=== | ===Nerve Testing=== | ||
*Median | *Median | ||
**Have pt flex distal phalanx of thumb against resistance | **Have pt flex distal phalanx of thumb against resistance | ||
** | **Have pt touch tip of thumb to tip of little finger | ||
**Sensation to distal 2nd digit | |||
*Ulnar | *Ulnar | ||
**Have pt spread the fingers apart against resistance | **Have pt spread the fingers apart against resistance | ||
**Interpose a piece of paper between thumb and index finger and try to pull paper away | **Interpose a piece of paper between thumb and index finger and try to pull paper away | ||
**Sensation to distal 5th digit | |||
*Radial | *Radial | ||
**Have pt make "thumbs up" | **Have pt make "thumbs up" | ||
**Sensation over the dorsal web space between the 1st and 2nd digits | |||
* | |||
* | |||
==Source== | ==Source== | ||
Tintinalli | Tintinalli | ||
[[Category:Ortho]] | [[Category:Ortho]] | ||
Revision as of 20:29, 5 January 2015
Background
- Must exam tendon injuries in their entirety through full range of motion
- Injuries w/ digits in flexion may cause retraction of cut end of tendon when examined in neutral position
- All exams should include a thorough hx of events
Exam
Inspection
- General appearance
- Palpate for: Crepitus, deformity, joint tenderness, rotation deformity, snuffbox tenderness
Motor
- Bilateral grip strength
- Have pt make a clenched fist
- Observe orientation and rotation of middle and distal phalanxes
- Assess for scissoring (overlapping of digits)
- All phalanges should be oriented parallel to each other w/ nails in same plane
- Have pt draw fingertips together so tip of thumb touches tips of the other 4 digits
- Gross estimation of intact median, ulnar, and radial nerve motor function
- Pincer function test
- Weakness suggests median nerve or ulnar collateral ligament disruption
Tendons
- Must test with resistance
- Pain along course of tendon during resistance testing suggests partial rupture
- Flexor digitorum profundus (FDP)
- Flex DIP against resistance while MCP and PIP joints are held in extension
- Flexor digitorum superficialis (FDS) + Flexor pollicis longus (FPL)
- Flex PIP against resistance while remaining fingers are held in extension
- Extensor tendons
- Hand flat an surface and lift fingers individually
Circulation
- Assess via cap refill and radial pulse
- Allen test
Nerve Testing
- Median
- Have pt flex distal phalanx of thumb against resistance
- Have pt touch tip of thumb to tip of little finger
- Sensation to distal 2nd digit
- Ulnar
- Have pt spread the fingers apart against resistance
- Interpose a piece of paper between thumb and index finger and try to pull paper away
- Sensation to distal 5th digit
- Radial
- Have pt make "thumbs up"
- Sensation over the dorsal web space between the 1st and 2nd digits
Source
Tintinalli