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Examination of the Hand, Examination of the Hand,

Wrist and Forearm Wrist and Forearm
February 19, 2004 February 19, 2004
The Purpose of the The Purpose of the
Shoulder and Elbow Shoulder and Elbow
is to position is to position
The HAND The HAND
Physical Examination is derived Physical Examination is derived
from Anatomic Knowledge from Anatomic Knowledge
Superficial Anatomy Superficial Anatomy
n n Anatomic Snuff Box Anatomic Snuff Box
n n Extensor Pollicis Brevis Extensor Pollicis Brevis
n n Extensor Pollicis Longus Extensor Pollicis Longus
n n Palpate Scaphoid Palpate Scaphoid
Superficial Anatomy Superficial Anatomy
Palpate Palpate
n n Distal Radius Distal Radius
n n Distal Ulna Distal Ulna
Superficial Anatomy Superficial Anatomy
n n Metacarpophalangeal Metacarpophalangeal
Joint (MCP) Joint (MCP)
n n Proximal Proximal
Interphalangeal Joint Interphalangeal Joint
(PIP) (PIP)
n n Distal Interphalangeal Distal Interphalangeal
Joint (DIP) Joint (DIP)
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Vascular Anatomy Vascular Anatomy
n n Radial Pulse Radial Pulse
n n Ulnar Pulse Ulnar Pulse
n n Allen Test Allen Test
Superficial Anatomy Superficial Anatomy
n n Thumb Extensor Tendons Thumb Extensor Tendons
n n 3 Joints = 3 Tendons 3 Joints = 3 Tendons
Superficial Anatomy Superficial Anatomy
n n Extensor Digitorum Communis Extensor Digitorum Communis
Superficial Anatomy Superficial Anatomy
n n Flexor Carpi Radialis Flexor Carpi Radialis
Superficial Anatomy Superficial Anatomy
n n Flexor Carpi Ulnaris Flexor Carpi Ulnaris
n n Palpate tendon Palpate tendon
n n Can you palpate the Can you palpate the
pisiform ? pisiform ?
Palmaris Longus Palmaris Longus
n n May not be present May not be present
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Heberden Node Heberden Node
n n Osteoarthritic Marginal Osteophytes Osteoarthritic Marginal Osteophytes
involving the Distal Inter involving the Distal Inter- -Phalangeal Joint Phalangeal Joint
(DIP) (DIP)
Bouchard Node Bouchard Node
n n Osteoarthritis with Marginal Osteophytes Osteoarthritis with Marginal Osteophytes
at Proximal Inter at Proximal Inter- -Phalangeal Joint (PIP) Phalangeal Joint (PIP)
Provocative Tests Provocative Tests
Carpal Tunnel Syndrome Carpal Tunnel Syndrome
n n Phalen Maneuver Phalen Maneuver
n n Tinel Sign over Median Tinel Sign over Median
Nerve Nerve
Provocative Test Provocative Test
De Quervain Tenosynovitis De Quervain Tenosynovitis
n n Finkelstein Maneuver Finkelstein Maneuver
Range of Motion Range of Motion
n n Forearm Rotation Forearm Rotation
n n Pronation Pronation
n n Supination Supination
Range of Motion Range of Motion
n n Wrist Wrist
n n Flexion = Palmar Flexion Flexion = Palmar Flexion
n n Extension = Dorsi Flexion Extension = Dorsi Flexion
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Range of Motion Range of Motion
n n Wrist Wrist
n n Radial Deviation Radial Deviation
toward the radius toward the radius
n n Ulnar Deviation Ulnar Deviation
toward the ulna toward the ulna
Range of Motion Range of Motion
n n Thumb Thumb
n n CMC CMC
n n Abduction Abduction
n n Adduction Adduction
n n MP MP
n n Flexion Flexion
n n Extension Extension
n n IP IP
n n Flexion Flexion
n n Extension Extension
Range of Motion Range of Motion
n n Finger Finger
n n MP MP
n n Flexion Flexion
n n Extension Extension
n n Abduction Abduction
n n Adduction Adduction
n n PIP & DIP PIP & DIP
n n Flexion Flexion
n n Extension Extension
Physical Examination Physical Examination
n n Sensory function Sensory function
n n Distributions of nerves Distributions of nerves
to hand to hand
n n Radial Radial
n n Median Median
n n Ulnar Ulnar
Physical Examination Physical Examination
n n Two Two- -point discrimination point discrimination
n n Smallest distance that patient can correctly Smallest distance that patient can correctly
identify on 2/3 trials identify on 2/3 trials
n n 5 mm normal 5 mm normal
n n >15 mm absent >15 mm absent
Physical Examination Physical Examination
n n Flexor Digitorum Profundus Flexor Digitorum Profundus
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Physical Examination Physical Examination
n n Flexor Digitorum Superficialis Flexor Digitorum Superficialis
n n Extend all other digits to isolate Extend all other digits to isolate
FDS and inhibit motion from FDP FDS and inhibit motion from FDP
Physical Examination Physical Examination
n n Motor exam Motor exam
n n Median Nerve Median Nerve
n nAll muscles of palmar All muscles of palmar
forearm except: forearm except:
n nFCU FCU
n nFDP ring FDP ring
n nFDP little FDP little
Physical Examination Physical Examination
n n Motor exam Motor exam
n n Ulnar Nerve Ulnar Nerve
n nAll muscles of hand except: All muscles of hand except:
n nAPB APB
n nOpponens Pollicis Opponens Pollicis
n nFPB superficial head FPB superficial head
n nLumbricals index & middle Lumbricals index & middle