HAND/WRIST EXAM

Question 0

Feel?

Answer 0

Warmth
Muscle wasting of the thenar/hypothenar

Wrist
Then MCP, PIP, DIP
- pain, swelling

Pain in anatomical snuff box

Question 1

What do you look for on examination?

Answer 1

HANDS
Scars  
Erythema
Swelling
Atrophy 
Nail changes 
- pitting, onycholysis
Deformities 
- Bouchards and heberdens node (OA) 
- Boutennieres, Swan neck or z thumb deformity (RA)  

Wrists
- deviation

Elbows

• rheumatoid nodules
• psoriatic plaques

Question 2

What movements?

Answer 2

Active
Wrist: prayer, phalens (inverted prayer)
Thumb: extension, abduct, adduct and opposition
MCP/IP: fist, straighten fingers

Passive
Wrist: dorsiflex, plantarflex
MCP/IP as a group

Question 3

What special tests?

Answer 3

Functional

• grip strength: squeeze my fingers, squeeze my finger between thumb and forefinger.
• open jar
• undo lock

Carpel tunnel
- tinnels