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

Exam

Motor

• Bilateral grip strength
• Have pt make a clenched fist
  • Observe orientation and rotation of middle and distal phalanxes
  • 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

Circulation

• Assess via cap refill and radial pulse

Nerve Testing

• Median
  • Have pt flex distal phalanx of thumb against resistance
  • have pt touch tip of thumb to tip of little finger
• 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
• Radial
  • Have pt make "thumbs up"

Tendons

• Must test with resistance
• Pain along course of tendon during resistance testing suggests partial laceration
• Flexor digitorum profundus
  • Flex DIP against resistance while MCP and PIP joints are held in extension
• Flexor digitorum superficialis
  • Flex PIP against resistance while remaining fingers are held in extension

Source

Tintinalli