- Hand and Wrist Assessment
Inspection
- Inspect dorsal and volar surfaces of each hand comparing both hands
- Radial and ulnar styloid
- Colles or Smith's fractures
- Radial deviation (OA) or ulnar deviation (RA)
- Carpal bones
- Metacarpals
- Dupuytren's contracture (usually 3rd/4th flexor tendons effected), extrahepatic sign of liver disease
- Metacarpophalangeal joints (MCP)
- Phalanges (proximal, intermediate and distal)
- Mallet finger of thumb
- Swan-neck and Boutonniere deformities (RA)
- Proximal interphalangeal joints (PIP)
- Bouchard nodes (OA)
- Inflammation (RA)
- Distal interphalangeal joints
- Heberden's nodes (OA)
- Psoriatic arthritis
- Thenar (median nerve) and Hypothenar (ulnar nerve) eminences
- Fingernails
- Pitting (psoriatic arthritis)
- Clubbing
- Capillary refill
Palpation
- Note areas of pain, swelling, spasm, muscular atrophy, ligamentous laxity, deformity, bogginess or crepitus in the following structures
- Inspect dorsal and volar surfaces of each hand comparing both hands
- Radial and ulnar styloid
- Colles or Smith's fracture
- Carpal bones
- Compress anatomical snuff box (scaphoid fracture)
- Surrounding scaphoid muscles
- Abductor pollicis longus
- Extensor pollicis brevus
- Extensor pollicis longus
- Distal radioulnar joint
- Metacarpals
- Dupuytren's contracture (usually 3rd/4th flexor tendons)
- Metacarpophalangeal joints (MCP)
- Compress for bogginess/warmth (RA)
- Phalanges (proximal, intermediate and distal)
- Proximal interphalangeal joints (PIP)
- Distal interphalangeal joints (DIP)
- Thenar (median nerve) and hypothenar (ulnar nerve) eminences
- Ulnar and radial pulses
Range of Motion
- Wrist ROM:
- Flexion (normal = 90°), "Palm toward forearm"
- Extension (normal = 90°), "Back of hand towards forearm"
- Ulnar deviation (normal = up to 30°), "5th finger towards forearm"
- Radial deviation (normal = up to 20°), "Thumb towards forearm"
- Digit II-IV ROM:
- MCP: 90° flexion, 20° extension, 15° abduction (digits II, IV, V away from III), adduction to touch adjacent digit (digits II, IV, V toward III)
- PIP: 100° flexion, 10° extension
- DIP: 80° flexion, 10° extension
- Thumb ROM:
- MCP: flexion, extension, abduction, adduction, opposition
- IP: flexion, extension
Special Shoulder Tests
- Carpal Tunnel Tests
- Hand Grip Test
- De Quervain's Tenosynovitis: Finkelstein's Test
- Sensation Testing
- Median nerve: pulp of index finger
- Ulnar nerve: pulp of fifth finger
- Radial nerve: dorsal web space of thumb and index finger
References
- Baxter, S. & McScheffrey, G. (2010). Toronto Notes: Comprehensive Medical Reference & Review for MCCQE 1 & USMLE 2. 26th ed. Toronto: Toronto Notes for Medical Students Inc; 2010.
- Bickley, L. (2013). Bates Guide to Physical Examination and History Taking. 11th ed. New York: Lippincott Williams & Wilkins; 2013.
- Filate, W., Leung, R., Ng, D. & Sinyor, M. (2005). Essentials of Clinical Examination Handbook. 5th ed. Toronto, ON. University of Toronto; 2005.