Hand Exam

Question 1

Steps

Answer 1

Look
Specific Tests for
- Rheumatoid Hand
- Dupuytrens Disease
- Neurological Conditions
- Hand Injury

Question 2

Look

Answer 2

Look for any muscle atrophy, postural changes or scarring

Ask patient to close fists in supine and prone

Question 3

Rheumatoid

Answer 3

• Inspection
• Fine Pinch
• Hold pen
• Squeeze fingers
• Resist decoupling of hands

Question 4

Dupuytrens

Answer 4

• Inspect
• See if patient can flatten palm on the table
• Measure angle
• Ask about this

Question 5

Neurological

Answer 5

• Test sensation in 1st joint space between thumb and finger (radial nerve) and side of pinky (ulnar) and tip of index (median)
• Ask patient to extend fingers and dont let you push them down
• Paper between pinky and ring finger and dont let me pull it out
• Dont let me push index finger in
• Thumbs and dont let me push it down
• Ask patient to grasp paper and dont let me pull it out

Question 6

Hand Injury

Answer 6

• Colour and cap refill
• Examine peripheral nerves (radial, ulnar and median)
• resist me pushing finger down
  1. with no stabilisation
  2. stabilising the mcpj
  3. stabilising the pipj
• Resist me pushing finger down

1. holding mcpj and ask patient to claw hand against resistance
2. Holding pipj and same