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Orthopaedics
Examination of the Hand
Built from Pillemer — Physical Signs in Orthopaedics and Neurology
What’s inside
3 sections · 61 slides
Overview
- What this topic teaches you
The Neurological Examination
Motor power, sensation, and blood supply of the hand
- Three nerves run the hand
- A plan for testing each nerve
- Median nerve - motor tests
- Testing thumb abduction
- Testing thumb opposition
- The thenar eminence
- Ulnar nerve - motor tests
- Fanning the fingers apart
- Closing the fingers together
- Froment's sign for thumb adduction
- Radial nerve - motor tests
- Extension of the wrist
- Extension of the fingers
- Extension of the thumb
- Intrinsic muscles - the fine-movement engines
- Adductor pollicis - the ulnar exception
- The median-supplied thumb intrinsics
- Sorting the interossei with 'PAD' and 'DAB'
- Extrinsic muscles - the long tendons
- How the two finger flexors divide the work
- Isolating the deep flexor (FDP)
- Isolating the superficial flexor (FDS)
- Testing the long thumb flexor (FPL)
- Sensory testing and the 'autonomous zones'
- Sensory map and the autonomous zones
- A 20-second screening test
- Testing sensation when the patient cannot cooperate
- The violin test for a dry fingertip
- The prune test for lost sweating
- Vascular testing - the Allen test
- Occluding both wrist arteries
- Blanching then re-perfusion of the hand
- Related nerve signs covered elsewhere
Tendon, Bone and Ligament Signs
Common hand and wrist conditions you can diagnose at the bedside
- DeQuervain's tenosynovitis
- Swelling of DeQuervain's tenosynovitis
- Finkelstein's test
- Lateral epicondylitis (tennis elbow)
- Tenderness over the lateral epicondyle
- Pain on resisted wrist extension
- Pain on resisted middle-finger extension
- Finger deformities from extensor tendon injury
- Boutonniere deformity
- Swan neck deformity
- Mallet finger deformity
- Scapholunate instability
- The scapholunate gap on X-ray
- Advanced collapse of the wrist
- Watson's test for scapholunate instability
- Watson's scaphoid shift test
- Ulnar collateral ligament instability
- Ulnar collateral ligament tear of the thumb
- Bunnell test for intrinsic tightness
- Bunnell test - reading the four patterns
- Key takeaways
- Putting the examination together
- References
- Physical Signs in Orthopedic and Neurologic Disorders: A Practical Guide