Hand And Wrist Examination
Back of Hand
Hands out flat palms down.
- Obvious swellings
- Loss of alignment
- Muscle wasting
- and Scars.
See if changes are symmetrical or a-symettrical.
- 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?
Look at the skin, for rashes, or signs of long term steroid use, such as thinning or bruising.
Finger pulp, palmar erythema, scars from carpal tunnel release
- Peripheral pulses
- Muscle bulk
- Tendon thickening
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.
Best felt by comparing the wrists, forearms and metacarpal pharyngeal joints.\\
- Squeeze across the metacarpal-pharyngeal joint, while watching patient's face
- Bimanually palpate any joints that appear swollen or enlarged.
Look at both for evidence of cirriosis or rheumatoid nodules, and feel along the ulnar border\\\
Wrist flexion and hyperextension should be assessed both actively and passively,
- Doing the let us pray position
- and then Do it upside down
Get the patient to spread their fingers out fully against gravity.
Test it by:
- Squeezing across
- and Pushing fingers up and down.
Turn your hands over and lift up your thumb.
- Abduction of thumb median nerve.
- Make a fist, and assess fingers passively.
- Power grip, and pincer grip.
- Pick up a small object.
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.