Hand exam: Difference between revisions
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===Nerve Testing=== | ===Nerve Testing=== | ||
*Median | *Median | ||
**Controls thumb abduction and 1st and 2nd lumbricals | |||
**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 | **Have pt touch tip of thumb to tip of little finger | ||
| Line 41: | Line 42: | ||
*Ulnar | *Ulnar | ||
**Have | **Controls thumb adduction and 3 and 4th lumbricals | ||
**Have patient 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 | **Sensation to distal 5th digit | ||
*Radial | *Radial | ||
**Have | **Controls thumb and wrist extension | ||
**Have patient make "thumbs up" while hand is | |||
**Sensation over the dorsal web space between the 1st and 2nd digits | **Sensation over the dorsal web space between the 1st and 2nd digits | ||
Revision as of 00:22, 24 November 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
- Controls thumb abduction and 1st and 2nd lumbricals
- 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
- Controls thumb adduction and 3 and 4th lumbricals
- Have patient 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
- Controls thumb and wrist extension
- Have patient make "thumbs up" while hand is
- Sensation over the dorsal web space between the 1st and 2nd digits