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Hand Exam

Introduction

Greetings
Hand wash
Verify the patient's identity using at least two or three details
Explanation
Consent
Expose both upper limbs, place hands on pillow on patient's lap
Ask if there's any pain and where
Confirm if patient is left or right handed

Look

Natural resting position

Clue to nerve or tendon damage

Scars
Colour alteration
Dry or moist
Hairy or smooth
Wasting

Thenar vs hypothenar eminence, small muscles of hand

Swelling

Diffuse vs localised (subcutaneous tissue, tendon sheath, joint)

Asymmetry between sides
Deformities with clenched fists

Feel

Warmth

Use back of hands, compare sides

Skin texture
Palpate for tenderness
CMCJs
MCPJs
Proximal PIPJs
Distal PIPJs

Move

Active movements
Fingers
Flexion

FDS/FDP/lumbricals

Extension

ED (+ EDM little finger)

Abduction

Dorsal interossei

Adduction

Palmar interossei

Thumb
Flexion

Flexor pollicis brevis

Extension
Palmar Abduction

Abductor pollicis brevis

Palmar Adduction

Adductor pollicis

Opposition

Opponens pollicis

Passive movements
Resisted movements
Grip strength

Squeeze examiner's fingers

Pinch grip
Resisted finger abduction
Resisted adduction

Hold piece of paper in 2nd web space and resist removal

Sensation

Ulnar nerve

C8/T1: Hypothenar, ulnar 1/3 palm, ulnar 1½ fingers palmar and dorsal

Median nerve

C5-T1: Thenar, radial 2/3 palm, radial 3½ fingers palmar, distal dorsal radial 3½ fingers

Radial nerve

C5-T1: Radial 2/3 dorsum of hand, proximal dorsal radial 3½ fingers

Special tests

Functional Tests
Opening a jar lid
Holding a key to open a door
Isolating FDS and FDP

Suspect direct flexor tendon injury if unable to flex one or more digits

Assessing Extensor Tendon Integrity

Extend PIPJ with MCPJ held in extension

Assessing for carpal tunnel
Tinel's test

Tap nerve in carpal tunnel to elicit pain in median nerve distribution

Phalen's manoeuvre

Hold wrist in flexion for 60 seconds

Assessment of Ulnar Collateral Ligament of 1st MCPJ

Stabilise 1st MCPJ in 10° flexion, stress thumb radially

IPJ Collateral Ligament Assessment

Stabilise phalanx above IPJ, stress joint with radial then ulnar deviation

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