Hand and Wrist OSCE

Question 1

Preparation:

Answer 1

Introduce self
Wash hands
Informed consent
Position - seated, exposed hands on pillow

Question 2

Look:

Answer 2

Posture - Z deformities/Ulnar deviation

Muscle wasting - thenar/hypothenar eminence

Scars (carpal tunnel)

Symmetry (contralateral joint)

Nails:

• Pitting
• Onycholysis
• Nail fold vascilitis
• Splinter Haemorrhages

Question 3

Feel

Answer 3

Joints (bimanual):

• DIP
• PIP
• MCP
• Wrists (+ wrist drop)

Temp:

• Forearm
• Wrist
• MCP

tenderness
swelling

General:

• Peripheral pulses
• thenar/hypothenar eminence
• tendon thickening
• Gentle touch - ulnar and median nerves

Question 4

Move

Answer 4

(passive and active) (crepitus)
Fingers:
- Extend
- Flex
- Abduct
- Adduct

Wrist:

• Flex
• Extend
• Phalens test

Question 5

Function

Answer 5

Power Grip

Pincer Grip

Pick up