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O - Hand Examination

step of hand examination

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Tham Yuen Sin
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31 views

O - Hand Examination

step of hand examination

Uploaded by

Tham Yuen Sin
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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HAND EXAMINATION

Look (c) Ulnar deviation of the fingers: d/t palmar grip


-put hand under pillow and thumb pressure naturally push the fingers
palmar ulnarwards
1. Muscle wasting (d) Boutonniere deformity: PIPJ flexion, DIPJ
- “praying hand position”: to check for Thenar and hyperextension
Hypothenar muscle wasting (e) Swan Neck Deformity: PIPJ hyperextension,
2. Finger cascade DIPJ flexion
-rotational deformity of the hand due to fracture (d) Rheumatoid nodule: rubbery lump at
of metacarpal and phalanges pressure areas
3. Pointing finger (e) Caput Ulnar Syndrome: Piano Key Sign
-median N lesion at elbow -DRUJ subluxation causing the head of the ulnar
pop up at the dorsum of wrist where it can be
jogged up and down
5. Gouty Tophi
-gout

- elbow
-d/t paralysis of 2nd and 3rd lumbricals and FDP 1. SC Nodule (RA)
(able to flex 4th and 5th fingers but not 2nd and 3rd)
Feel
4. Ulnar claw hand 1. Temperature
-Ulnar N lesion 2. Tenderness of each joint
-Wrist J, MCPJ, PIPJ, DIPJ
3. Pulse: Radial Artery Pulse

Move
Screening test=OK sign
-d/t paralysis of 4th and 5th lumbrical (X flex MCPJ 1. Extension of wrist & finger: Radial N
and extension of IPJ) 2. Abduction of finger: Ulnar N
3. O: Median N
5. Benediction sign
-differentiate pointing finger (ask patient to make a Specific test
fist) and claw hand (at rest already can see) 1. Elbow: extension, flexion
2. Wrist: extension, flexion
dorsum 3. Finger: AB, AD
1. Ganglion 4. Thumb: Flexion, Extension, AB, AD
2. Ulnar guttering/ muscle wasting
-hypothenar muscle wasting
3. Stigmata of OA
(a) Heberden node: @ DIPJ
(b) Bouchard node: @ PIPJ
4. Stigmata of RA
(a) Z thumb deformity: MCPJ hyperextension, IPJ
flexion
(b) Volar subluxation of MCP
SPECIAL TEST
Motor Sensory Lesion
Ulnar N 1. Froment test Medial 1.5 digit @wristulnar claw hand
-to test AdPB -paralysis of 4th & 5th
-put a piece of paper lumbricals (X ext MCPJ &
between pt’s thumb and flex IPJ)
2nd digit ask to grip as
strong as possible @elbowulnar paradox
-paralysis of FCU (X flexion
2. DAP, PAD straighter 4th & 5th finger)
-ask patient to open and
close finger

3. Cross finger test


-ask pt to cross 2 fingers
together
-to test interosseous
muscle
Median N 1. OK sign Lateral 3.5 digit @wristCTS
2. OP fx 1. Tinel Sign
-ask pt to do opposition of -light tapping pt’s transverse
thumb carpal ligament (slightly
3. AbPB fx below the wrist) to detect
-ask pt to abduct the paraesthesia
thumb
2. Phalen’s test
-flex the wrist

3. Dunkan Test
-press thumb over wrist and
hold for 30 s to detect
paraesthesia

4. Thenar Muscle Wasting

@elbowUlnar Claw Hand


Radial N 1. Wrist extension First web space & @wristnone
2. Finger extension anatomical snuff box @humerusfinger & wrist
drop

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