Examination of Hand and Wrist

Question 1

How do you position the patient

Answer 1

Patients hands resting on a pillow

Question 2

Wat are you inspecting?

Answer 2

Look for scars

Wounds

Thinning of skin

Rashes

Nails - for signs of clubbing, psoriatic changes (pitting onycholysis) splinter haemorrhage, nail fold vasculitis

Posture of hand and wrist (any fracture or deformity)

Muscle wasting

Bouchard’s nodes (PIP join) and Heberden’s nodes (DIP joint)

Dupuyten’s disease

Question 3

What do you feel for?

Answer 3

Temperature

Pulse

Muscle bulk (thenar and hypothenar eminences)

Sensation of median (tip of index finger + thenar eminence), ulnar (tip of little finger and hypothenar eminence) and radial (first web space on dorsum of hand) nerves

Palpate for tenderness

Bimanual palpation on joints that are swollen or painful for tenderness and fluctuation

Palpate the MCP and wrist joint with thumbs above and index fingers below

Question 4

What do you move?

Answer 4

Straighten fingers

Make a fist

(check allignment)

Prayer sign

Revers prayer sign

(actively and then passively)

Phalen’s test

and/or

Tinel’s test

Assess radial,median and ulnar nerve power

Question 5

How do you assess function?

Answer 5

Ask patient to grip your two fingers

Pincer: ask patient to pick up a small object