MSK Examination - Hand and Wrist Flashcards
What should be used to rest the patient’s hand?
A pillow
What is important to note regarding the abnormalities?
Symmetrical or asymmetrical
Name the 2 carpal tunnel tests and describe them
Phalen’s test - wrist is held in full flexion (reverse prayer) for 60 seconds. Should elicit symptoms if pos.
Tinel’s test - lightly tap the median nerve as it passes through wrist. +ve is tingling in in thumb, index and middle fingers
List off what you inspect for on the hands overall
Scars, wounds, rashes Thinning of skin due to steroid use Posture of the whole hand and wrist Any deformities in fingers Muscle wasting Bouchard's nodes in the PIP joint Heberden's nodes in the DIP joint
Look - nails?
Clubbing
Psoriatic changes like pitting
Splinter hemorrhages
Nail fold vasculitis
Look - palm?
Muscle wasting
Fascial thickening for dupuyten’s
List off the things you feel for in papation.
Feel the temp in the forearm, wrist and back of hands
Assess radial pulse
Feel the bulk of the thenar and hypothenar eminences
Palpate for tenderness in one location at a time while watching patients face
Palpate fingers using thumb and index finger to encircle the joints
Palpate the MCP and wrist joints with thumb above and finger below
Assess sensation of median, ulnar and radial nerves
How do we assess the sensation of these nerves?
Median - touch tip on index finger and thenar eminence
Ulnar - touch volar tip of little finger and hypothenar eminence
Radial - touch the 1st web space on dorsum of hand
Movement - fingers?
Ask patient to straighten them and make a fist, check alignment
If there’s an abnormality, passivity assess fingers
Movement - wrist?
Ask patient to make a prayer sign (and lift elbows) and reverse prayer sign for flexion and extension
Then do each hand passively while feeling for crepitus
Do a carpal tunnel test
Function tests?
Power grip - squeeze fingers
Pincer grip - pick up a small object
Examine the elbow joint
