Hand exam: Difference between revisions
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==Background== | ==Background== | ||
*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 | **Injuries with 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 | *All exams should include a thorough hx of events | ||
| Line 14: | Line 14: | ||
**Observe orientation and rotation of middle and distal phalanxes | **Observe orientation and rotation of middle and distal phalanxes | ||
**Assess for scissoring (overlapping of digits) | **Assess for scissoring (overlapping of digits) | ||
**All phalanges should be oriented parallel to each other | **All phalanges should be oriented parallel to each other with nails in same plane | ||
*Have patient draw fingertips together so tip of thumb touches tips of the other 4 digits | *Have patient 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 | **Gross estimation of intact median, ulnar, and radial nerve motor function | ||
Revision as of 23:34, 11 July 2016
Background
- Must exam tendon injuries in their entirety through full range of motion
- Injuries with 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 patient 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 with nails in same plane
- Have patient 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 opposition and 1st and 2nd lumbricals
- Have patient touch tip of thumb to tip of little finger with a paper in between. Pull paper away.
- Sensation to distal 2nd digit
- Ulnar
- Controls thumb adduction and 3 and 4th lumbricals
- Have patient spread the fingers apart against resistance
- Interpose a tongue deppressor between thumb and index finger and try to pull radially
- 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