Hand examination

LOOK NEUROVASCULAR TEST 7 functions of the hand:

Skin ● discoloration ● Sensation Sensory territories and innervations of the hand 1) Power Grip – squeeze my fingers
-erythema (cellulitis) two-point discrimination 2) Hook Grip – hook my hand
-white (arterial insufficiency) ● Motor 3) Precision Grip hold pen
-blue/purple (venous congestion) radial nerve: test thumb IP joint extension against resistence 4) Lateral Pinch Grip – key grip
-black spots (melanoma) median nerve 5) Tip Pinch – pick up coin
-trophic changes recurrent motor branch: palmar abduction of thumb 6) Hand grasp
● scars/wounds anterior interosseous branch: flexion of thumb IP and index DIP ("A-OK sign") 7) Paperweight
Swelling ulnar nerve: cross-fingers or abduct fingers against resistence
Muscle ● thenar atrophy ● Vascular
atrophy median nerve involvement radial pulse
caused by carpal tunnel syndrome ulnar pulse
● interossei atrophy Allen's test
ulnar nerve involvement capillary refil
caused by cubital tunnel or cervical
radiculopathy NERVE ASSESSMENT
● subcutaneous atrophy Tinel's -tests for carpal tunnel syndrome
locally post-steroid injection -examiner percusses with two fingers over distal palmar
Deformity ●asymmetry crease in the midline
●angulation -positive if patient reports paresthesias in median nerve
●rotation distribution
●absence of normal anatomy (previous - also to test for nerve regeneration-look for pain for site
amputation) of raw nerve ending
●cascade sign Phalen's -tests for carpal tunnel syndrome
Fingers converge toward the scaphoid with the hands pointed up, the patient's wrist is allowed to
tubercle when flexed at the MCPJ and PIPJ flex by gravity in palmar flexion for 1 minutes maximum
if one or more fingers do not converge, then -positive if patient reports paresthesias in median nerve
trauma to the digits has likely altered normal distribution
alignment Carpal -For carpal tunnel
FEEL compression - pressure on transverse carpal ligament
● Masses (ganglions, nodules) Wrist masses (ganglions, nodules) test -positive if numbness
● Temperature Froment's tests for ulnar nerve motor weakness
warm: infection, inflammation sign patient asked to hold a piece of paper between thumb and
cool: vascular pathology radial side of index
● Tenderness positive if as the paper is pulled away by the examiner the
● Crepitus (fracture) patient flexes the thumb IP joint(FPL) in an attempt to
● Clicking or snapping (tendonitis) hold on to paper
● Joint effusion (infection, inflammation, trauma) Wartenberg's tests ulnar nerve motor weakness
sign patient asked to hold fingers fully adducted with MCP, PIP,
MOVE and DIP joints fully extended
Screen by positive if small finger drifts away from others into
-grip & open hand abduction
-make OK sign Jeanne's sign tests for ulnar nerve motor weakness
-prone & extend (claw) ask patient to demosntrate key pinch
-gong xi fa cai hand-HOB positive finding if patients first MCP joint is hyperextended
Hand examination
LOOK NEUROVASCULAR TEST 7 functions of the hand:
Skin ● discoloration ● Sensation Sensory territories and innervations of the hand 1) Power Grip – squeeze my fingers
-erythema (cellulitis) two-point discrimination 2) Hook Grip – hook my hand
-white (arterial insufficiency) ● Motor 3) Precision Grip hold pen
-blue/purple (venous congestion) radial nerve: test thumb IP joint extension against resistence 4) Lateral Pinch Grip – key grip
-black spots (melanoma) median nerve 5) Tip Pinch – pick up coin
-trophic changes recurrent motor branch: palmar abduction of thumb 6) Hand grasp
● scars/wounds anterior interosseous branch: flexion of thumb IP and index DIP ("A-OK sign") 7) Paperweight
Swelling ulnar nerve: cross-fingers or abduct fingers against resistence
Muscle ● thenar atrophy ● Vascular
atrophy median nerve involvement radial pulse
caused by carpal tunnel syndrome ulnar pulse
● interossei atrophy Allen's test
ulnar nerve involvement capillary refil
caused by cubital tunnel or cervical
radiculopathy NERVE ASSESSMENT
● subcutaneous atrophy Tinel's -tests for carpal tunnel syndrome
locally post-steroid injection -examiner percusses with two fingers over distal palmar
Deformity ●asymmetry crease in the midline
●angulation -positive if patient reports paresthesias in median nerve
●rotation distribution
●absence of normal anatomy (previous - also to test for nerve regeneration-look for pain for site
amputation) of raw nerve ending
●cascade sign Phalen's -tests for carpal tunnel syndrome
Fingers converge toward the scaphoid with the hands pointed up, the patient's wrist is allowed to
tubercle when flexed at the MCPJ and PIPJ flex by gravity in palmar flexion for 1 minutes maximum
if one or more fingers do not converge, then -positive if patient reports paresthesias in median nerve
trauma to the digits has likely altered normal distribution
alignment Carpal -For carpal tunnel
FEEL compression - pressure on transverse carpal ligament
● Masses (ganglions, nodules) Wrist masses (ganglions, nodules) test -positive if numbness
● Temperature Froment's tests for ulnar nerve motor weakness
warm: infection, inflammation sign patient asked to hold a piece of paper between thumb and
cool: vascular pathology radial side of index
● Tenderness positive if as the paper is pulled away by the examiner the
● Crepitus (fracture) patient flexes the thumb IP joint(FPL) in an attempt to
● Clicking or snapping (tendonitis) hold on to paper
● Joint effusion (infection, inflammation, trauma) Wartenberg's tests ulnar nerve motor weakness
sign patient asked to hold fingers fully adducted with MCP, PIP,
MOVE and DIP joints fully extended
Screen by positive if small finger drifts away from others into
-grip & open hand abduction
-make OK sign Jeanne's sign tests for ulnar nerve motor weakness
-prone & extend (claw) ask patient to demosntrate key pinch
-gong xi fa cai hand-HOB positive finding if patients first MCP joint is hyperextended