Hand exam

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