Physical Exam Hand

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Introduction

• Follows the IP-PASS examination methodology
  • Inspection
  • Palpation
  • Passive Range of Motion
  • Active Range of Motion
  • Strength & Neurovascular
  • Special Tests

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Inspection

• Skin
  • Color: erythema, ecchymosis, pallor, black
  • Trophic changes (altered hair growth, sweat production)
  • Scars
• Swelling
• Muscle tone
  • Thenar atrophy: Median Nerve injury
  • Interosseus atrophy: Ulnar Nerve Injury
• Deformity
  • Asymmetry
  • Radial or ulnar deviation
  • Rotation
  • Amputation
  • Athritic nodes
  • Butonniere
  • Swan Neck
• Angulation: Cascade Sign

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Palpation

• Joint Effusion
• Clicking
• Snapping
• Crepitus
• Tenderness
• Temperature
• Masses

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Range of Motion

• Finger
  • MCP: 0° - 85°
  • PIP: 0° - 110°
  • DIP: 0° - 65°
• Wrist
  • Flexion: 60°
  • Extension: 60°
  • Radioulnar Deviation: 50°

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Strength and Neurovascular

• Sensation
  • Recommend: 2 point discrimination (use paper clip)
  • Light touch
• Motor:
  • Median Nerve: “A-OK” sign: flexion of thumb and index finger or thumb and pinky against resistance
  • Ulnar Nerve: Test fingers against resistance in abduction
  • Radial Nerve: Test thumb extension against resistance
• Vascular
  • Radial pulse
  • Ulnar pulse
  • Allen’s Test

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Special Tests

• De Quervains Tenosynovitis
  • Finkelstein's Test
  • Eichhoff's Test
• Central Slip Extensor Tendon Injury
  • Elson's Test
• Gamekeeper’s Thumb
  • UCL Stress Test (Thumb)
• TFCC Injury
  • TFCC Shear Test
  • TFCC Stress Test
• Wartenbergs Syndrome
  • Tinel’s Test
  • Finkelstein's Test
• Carpal Tunnel Syndrome
  • Tinels Test
  • Phalens Test
  • Durkans Test
• Scapholunate Instability
  • Scaphoid Shift Test
• Lunotriquetral Instability
  • Reagans Test
  • Kleinmans Shear Test
• Distal Radial Ulnar Joint Instability
  • Piano Key Test
• Carpometacarpal Arthritis
  • Thumb CMC Grind Test
• Other
  • Passive Hand Stretch Test: Distal Radius Fracture, Scaphoid Fracture, Hand Compartment Syndrome

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See Also

• Hand and Wrist Anatomy (Main)
• Finger Pain (Main)
• Hand Pain (Main)

External Links

• Sports Med Review Hand Pain: https://www.sportsmedreview.com/by-joint/hand/
• JAMA: Examination of the Hand and Wrist

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