Hand Exam

Question 1

Nerve damage in ape hand

Answer 1

Median Nerve

Question 2

Nerve damage in claw hand

Answer 2

Median/ulnar nerve

Question 3

Nerve damage in bishop’s hand

Answer 3

Ulnar nerve

Question 4

Nerve damage in wrist drop

Answer 4

Radial Nerve (extensors don’t work yanno)

Question 5

What are we observing in appearance for a hand evaluation?

Answer 5

UE/head/neck position
Gross atrophy
Edema
Tone
Scars
Color
Moisture (ew)
Deformed nails
Contractures

Question 6

What are Bouchard’s nodes?

Answer 6

Swelling in PIPs

Question 7

What are Heberden’s nodes?

Answer 7

Swelling in DIPS

Question 8

What is mallet finger?

Answer 8

Straight PIPs, flexed DIP

Question 9

Swan neck contracture

Answer 9

Extended PIP, flexed DIO+P

Question 10

Boutonnière Contracture

Answer 10

Flexed PIP, extended DIP

Question 11

More than 10 mL difference in volumetric measurements

Answer 11

“Archimede principle of water displacement”

Means swelling!

Question 12

Procedure for edema measurement in hand

Answer 12

1- Overfill tank slightly, let water drain
2- Immerse limb slowly until 3rd web hits stop rod, collect displaced water in graduated cylinder
3- Record graduated cylinder volume in mL

Question 13

For edema measurement, what amount of displaced water represents swelling?

Answer 13

More than 10 mL

Question 14

Variables that decrease accuracy of hand edema measurement

Answer 14

• aerated hose
• limb motion
• inconsistency of pressure on stop rod

Question 15

For all digital measurements keep wrist _______.

Why?

Answer 15

Neutral–avoid tension from opposing extrinsic muscle groups

Question 16

How to perform digital ROM:

Answer 16

1- measure mP flexion in intrinsic positive mosition
2- Measure PIP/DIP flexion together with MP in extension
-Stabilized/blocked/isolated ROM (not complete flexion)
3- After flexion measurements, record ext. by asking for composite extension

Question 17

What is TAM?

Answer 17

Sum of active flexion measurements at MP, PIP, DIP, minus active extension deficits

Question 18

What is TPM?

Answer 18

Same as TAM BUUUT passive flexion/extension measurements used

Question 19

Normal TAM value

Answer 19

220-240

Question 20

Normal TPM measurements

Answer 20

240-260

Question 21

Normal Index MCP AROM/PROM

Answer 21

0-70, 0-80

Question 22

Normal Index PIP AROM/PROM

Answer 22

20-50, 10-70

Question 23

Normal Index DIP AROM/PROM

Answer 23

20-50, 10-55

Question 24

Thumb abduction AKA

Answer 24

Radial abduction

Question 25

MP Capsular Pattern

Answer 25

More restriction in flexion than extension

Question 26

IP capsular pattern

Answer 26

More restriction in extension than flexion

Question 27

Wrist capsular pattern

Answer 27

Equal loss of DF and flexion

Question 28

CMC capsular pattern

Answer 28

Abduction and extension limited...flexion relatively free

Question 29

Middle finger normal mcp arom/prom

Answer 29

0-90, 0-90

Question 30

Middle finger PIP arom/prom

Answer 30

50-100, 45-110

Question 31

Middle finger DIP arom/prom

Answer 31

0-70, 0-70

Question 32

What is volar surface?

Answer 32

Palm of hand

Question 33

Passive restriction to extension?

Answer 33

Volar plate adhesions, volar skin contracture, bony block, flexion tendon adhesion

Question 34

Passive restriction to flexion indicative of

Answer 34

Dorsal skin tightness, extensor tendon scar/tightness

Question 35

Active restraint to extension indicative of

Answer 35

Passive restraint/extensor lag

Question 36

Active restraint to flexion indicitive of

Answer 36

Passive restraints or flexor tendon rupture/adhesion

Question 37

What can cause active restraint to flexion?

Answer 37

Some sort of. Trauma

Question 38

Limited composite passive flexion-pattern:

Answer 38

Extensor tendon tightness, dorsal skin tightness

Question 39

Limited composite active flexion with normal composite passive flexion-pattern

Answer 39

Flexor tendon adhesion or rupture

Question 40

Oblique Retinacular Ligament Tightness test

Answer 40

- DIP Passively flexed with PIP in extension, then flexion - Greater motion with PIP flexion: ligament contracture - If DIP joint bends easily with PIP joint flexed but not when extended, then tight/contracted ligament (if DIP is tight in both, then probably a capsular problem)

Question 41

Intrinsic Tightness Test

Answer 41

- Intrinsics on passive stretch (MP extension and IP flexion), then relaxed via MP flexion - If PIP can be passively flexed more with MP joint in flexion than extension = positive test for tightness

Question 42

Partial range = 2 for which MMTs

Answer 42

Finger abduction/adduction, APL, opposition

Question 43

How to perform dynamometer testing?

Answer 43

- Pt sitting, shoulder adducted at side, elbow flexed 90, wrist in 0-30 extension/ 0-15 ulnar deviation - Adjust one of five handle position - Perform one squeeze each position/three squeezes in one position--average readings - Alternate R/L to avoid fatigue

Question 44

Phalen's test

Answer 44

The swan test for carpel tunnel where you sit there for one minute--pos for parathesias ***median nerve

Question 45

Tinel's sign

Answer 45

Tap over carpal tunnel--positive ulnar nerve impingement if. Parathesias

Question 46

Froment's sign

Answer 46

- APL/B weakness vs ulnar nerve paralysis - Grasp paper between them/radial side of index finger - Positive sign = terminal phalanx flexes or mcp hyperextends

Question 47

Finkelstein's Test (probably not that good)

Answer 47

- Tenosynovitis of AbPL/EPB * **deQuervian's disease - fist while holding thumb inside and ulnar deviate - positive = pain in area of tendons

Question 48

What is more commonly used-- static grip testing or rapid exchange testing?

Answer 48

Static grip (usually 3 x each side instead of switching hands back and forth quickly)