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Hand And Wrist Examination

Look

Back of Hand

Hands out flat palms down.

Look for:

  • Obvious swellings
  • Loss of alignment
  • Muscle wasting
  • and Scars.

See if changes are symmetrical or a-symettrical.

Nails

Look for:

  • sciatic changes
  • pitting or oedema
  • other signs such as nailfold vasculatis.

If there is swelling, look to see which joints are affected, the distal interpharyngeal joints, the proximal, the metacarpal-pharyngeal or the wrists?

Skin

Look at the skin, for rashes, or signs of long term steroid use, such as thinning or bruising.


Palms

Finger pulp, palmar erythema, scars from carpal tunnel release

Feel

  • Peripheral pulses
  • Muscle bulk
  • Tendon thickening

Sensation

Check median and ulnar sensation, by touching gently over the thenar and hyperthenar eminences, or the index and little fingers, respectively.

  • Radial nerve sensation is best felt over the thumb and index finger web space.

Temperature

Best felt by comparing the wrists, forearms and metacarpal pharyngeal joints.\\

Squeeze

  • Squeeze across the metacarpal-pharyngeal joint, while watching patient's face
  • Bimanually palpate any joints that appear swollen or enlarged.

Elbows

Look at both for evidence of cirriosis or rheumatoid nodules, and feel along the ulnar border\\\

Move

Wrist

Wrist flexion and hyperextension should be assessed both actively and passively,

  • Doing the let us pray position
  • and then Do it upside down

Fingers

Get the patient to spread their fingers out fully against gravity.
Test it by:

  • Squeezing across
  • and Pushing fingers up and down.

Thumb

Turn your hands over and lift up your thumb.

  • Abduction of thumb median nerve.

Hand

  • Make a fist, and assess fingers passively.
  • Power grip, and pincer grip.
  • Pick up a small object.

Grand finale

Finish with Phalen's test. Forced flexion of the wrist (inverse let us pray) for 60 seconds, reproducing the patient's symptoms, if any, of carpal tunnel syndrome.