Download 3. Hand and Wrist Assessment

Wrist and Hand Assessment
Scan Exam
Elbow
Flexion, Extension
Pronation, Supination
Fingers
Full fist, Half fist
Palmar Surface
atrophy- thenar (median n), hypothenar (ulnar n)
Dorsal Surface
knuckles- 3rd more prominent or all in line?
muscle wasting
shape of nails (clubbed, spoon, pitting, psoriasis)
swelling (ganglion cyst)
Heberden’s nodes (OA of DIP)- Bouchard’s nodes (OA of PIP)
finger/hand deformities (swan neck, boutonniere, mallet/dropped, ulnar claw, median
n palsy, trigger finger, dupuytren’s contracture
General
count fingers, size of hands, hand in resting position, atrophy
Nerve Root
Dermatome
Myotome
C4
clavicle ring
shrug
C5
lateral deltoids
shoulder abduction
biceps
C6
thumb side
elbow flex/wrist ext
brachioradialis
C7
middle finger
elbow ext/wrist flex
triceps
C8
pinkie
finger flex (claw)
T1
medial elbow
finger abd/add
Grading
↓ or normal or ↑
5/5
Active
Passive
Resisted
radial deviation
ulnar deviation
30-40°
Grade 5/5
wrist flexion
80-90°
w over pressure
Observations
bumps, bruises
scars, redness
rash, psoriasis
moles, skin tags
swelling, trauma
Neurological
* test bilaterally
Movement
Testing
* painful last
* passive w
overpressure
Reflex
Reflex Response:
0=absent
1+=diminished
2+=normal
3+=brisk
4+=non sustained
clonus, very brisk,
clonus (rhythmic
movement in response
to reflex)
5+=sustained clonus
* map out peripheral
* sharp dull
2+ normal
15°
bone-bone
wrist extension
tissue stretch
finger Flexion
finger Extension
finger abduction
thumb flexion
thumb extension
85-105°
abnormal end feels:
-sudden/hard (mm spasm/guard)
-capsular (soft- edema, hardfrozen)
-boney (osteophytes)
-empty (pain limits- bursitis)
-springy block (meniscal)
Opposition
Thumb Adduction
70-90°
20-45°
20-30°
45-90°
0-5°
5th finger tip
tissue approx
30°
Wrist and Hand Assessment
Palpation
Bony
* location
* size/shape
* tone/texture
* temperature
* edema
* trigger points
radial/ulnar styloid, tubercle of radius (listers tubercle)- in line with lunate
carpal bones (scaphoid, lunate, triquetrium, pisiform, trapezium, trapezoid, capitate,
hamate)
hook of hamate -tunnel of guyon (passage for ulnar nerve)
1st MT- game keepers thumb
5th MT- bar room fx
Soft Tissue
zone 1: radial
styloid
tunnel 1:
EPB, AbPL - site of De Quervain’s disease
zone 2:
at lister’s tubercle
tunnel 2:
ECRL/B
tunnel 3:
EPL - commonly ruptured with RA
tunnel 4:
ext digitorum, ext indicis (ganglion cysts)
tunnel 5:
ext. digiti minimi tendon
tunnel 6:
ext. carpi ulnaris tendon
Wrist:
zone 3: ulnar
styloid
zone 4:! pisiform & palmar aspect, FCU, tunnel of guyon, ulnar artery
zone 5: !palmaris longus, carpal tunnel
Special Tests
Hand:
zone 1: thenar emience
zone 2: hypothenar eminence
zone 3: palmar aspect- aponeurosis, finger flexor tendons
zone 4: dorsum of hand- ext. tendons
zone 5: phalanges
Ligament
Instability
Tests
1. DRUJ Ballotement Test- instability of DRUJ
2. Piano Key Test- instability DRUJ
3. Thumb UCL Laxity Test- ulnar collateral ligament of the thumb
Muscle,
Tendon, Joint
Path
1. Murphy’s Sign- lunate dislocation
2. Anatomical Snuff box compression Test- fx of scapoid
3. Finkelstein’s Test- De Quervain’s (stretch)
4. Brunelli’s Test- De Quervain’s (contract)
5. Bracelet Test- RA
Neurological
Tests
1. Tinel’s at the wrist- integrity of median nerve
2. Phalen’s/Reverse Phalen’s Test- integrity of median nerve
3. Carpal Compression Test- integrity of median nerve
4. Wringing Test- non specific test to localize wrist pain
5. Froment’s Sign Test- ulnar nerve
6. Pinch Grip Test- injury of anterior interosseous nerve (branch of median nerve)
Vascular Test
1. Allen’s Test- tests blood flow through radial/ulnar arteries
Condition
Description
Bennett’s Fx
base of thumb
Game Keepers thumb
ulnar collateral ligament instability
Bar Room fx
5th MT
Colles fx
fx of distal radius & dorsal displacement with or without
ulnar fx
CTS
compression of median nerve
Kienbocks
lunate dislocation- avascular necrosis