Hand

Question 1

Hand Examination
SMSM CDTT

Answer 1

Skin
Muscle weakness
Swelling
Movement
Crepitus
Deformity
Tenderness
Special tests

Question 2

1- Skin:

Answer 2

look for :
* palmar erythema.
*ulcers.
* scar for carpuel tunnle syndrome

Question 3

2-Muscle wasting

Answer 3

look for wasting in:
*thenarالصباع الكبير.
* hypothenar الصباع الصغير
* hand guttering (grooving)
Dorsal interosseous muscles.
ضعف في عضلات ضهر الايد..
هتلاقي العضم بتاع metacarpal ضهر الايد بارز )

Question 4

3-Swelling

Answer 4

3-Swelling:
look for effusion, synovium, bony, SC nodules.
وبنفرق بين bony swelling,s.c nodules ازاي؟
*Concistency …bone hard ثابت ميتحركش, s.c nodule firm compressible
*Movability ..s.c nodule moblie
طب ايه انواع bone swelling اللي ممكن تشوفها؟
Heberden’s and
Boucherd’s Nodules:
bony swilling (osteophytes)
present in PIP (Bouchard)
and DIP ( Heberden’s)
Occurs in osteoarthritis.

Question 5

هتعمل swelling examination ازاي؟

Answer 5

واحنا بنعمله هنعمل tenderness معاه بالمرة
1- هتمشي ضهر ايدك علي ضهر ايد العيان عشان لو في swelling في extensir surface يبان.
2- هتمسك العيان من عند shaft مش wrist
3- هناخدهم مفصل مفصل من الجنب الاول وبعدين فوق وتحت ولو لقيت swelling هنوصفه
4- grades of tenderness :
1- Patient says. يقول
2- Patient winces. المريض وجهه ينكمش من الالم
3- Patient withdraws. يسحب ايده
4- Patient refuse joint
touch.

Question 6

4-Movement

Answer 6

Examine Range of movement (ROM) (active & passive)
عشان افرق بين articular, extra articular
لو لقيت active=passive تبقي المشكلة articular في العضم يعني
لو لقيت passive اكتر تبقي extra articular يبقي المشكلة في tendon, synovial mbrane
*Fingers Extention.
* Fingers flexion.
* Wrist flexion
*Wrist extension
*Opponents muscles.
خلي كل صباع يلمس الصباع الكبير

Question 7

Crepitus
الطرقعة

Answer 7

start from MCP and wrist
حط ايدك علي المفصل وقوله اتحرك هتسمع صوت الطرقعة

Question 8

Deformities & describe it:

Answer 8

• Ulnar deviation (at the level of MCP)
• Radial deviation (at the level of wrist)
  *Swan neck: رقبة البجعة
  Hyperextension at PIP joint, hyperflexion at DIP.
  #
  *boutonniere: عروة الزرار
  Hyperflexion at PIP joint with hyperextension at DIP
• Z shaped thumb:
  Fixed flexion and subluxation at the MP joint and hyperextension at the IP joint.
  *Trigger finger: زناد
  (Flexion الاتنين)
  Flexion at both PIP and DIP due to nodule trapped behind the tendon.
  • Fusiform finger: Swilling of the PIP
  • Mallet finger:
  اصبع المطرقة او اصبع البيسبول
  injury to the tendon that straighten the PIP, Result in inability to straighten the last joint.

Question 9

Tenderness:

Answer 9

Examine for tenderness
in joints or surrounding
structures.
► Grades of Tenderness:
1- Patient says.
2- Patient winces.
3- Patient withdraws.
4- Patient refuse joint
touch.

Question 10

8- Special Test: e.g. Carpal Tunnel syndrome:

Answer 10

Phalen’s test:
The patient is asked to hold their wrist in complete
and forced flexion (pushing the dorsal surfaces of
both hands together) for 30-60 seconds

Question 11

8- Special Test: e.g. Carpal Tunnel syndrome:

Answer 11

Tinnel’s Test:
Lightly tap over the nerve to elicit a sensation of
tingling or in the distribution of the nerve.