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Hand and Wrist Examination: Difference between revisions
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==Inspection== | |||
* Expose both limbs to the elbow | |||
** All aspects | |||
** Don’t forget forearm or ulna aspects | |||
* Seated, hands on pillow or desk | |||
** Posture/alignment | |||
** Tremor | |||
** Swelling | |||
** Colour | |||
** Wasting | |||
** Scars | |||
==Movement== | |||
* Wrist | |||
** Observe supination/pronation rhythm as you inspect | |||
** Flexion/extension | |||
** Radial/ulnar deviation | |||
** Pronation/supination | |||
* Fingers | |||
** Flexion/Extension | |||
** MCPJs – 0-90° | |||
** PIPJs – 0-110° | |||
** DIPJs – 0-90° | |||
** Abduction/Adduction | |||
* Thumb | |||
** Adduction, abduction, opposition, flexion, extension | |||
* Note any [[:Category:Heritable Connective Tissue Disorders|hypermobility and skin hyperextensibility]]. | |||
==Palpation== | |||
Assess landmarks for tenderness, swelling (ganglions, dactylitis, synovitis, bone or soft tissue), temperature, vasomotor, and sudomotor changes. | |||
'''Landmarks''' | |||
[[File:Wrist palpation landmarks.png]] | |||
'''Dorsal Wrist Pain''' | |||
[[File:dorsal-wrist-pain.jpg]] | [[File:dorsal-wrist-pain.jpg]] | ||
:A = Intersection syndrome | :A = Intersection syndrome | ||
:B = De Quervain’s tenosynovitis | :B = De Quervain’s tenosynovitis | ||
Line 25: | Line 52: | ||
:L = ECU dislocation / tendonitis | :L = ECU dislocation / tendonitis | ||
{{ | '''Volar Wrist Pain''' | ||
[[File:volar-wrist.jpg]] | |||
:A = FCU tendonitis | |||
:B = Pisiotriquetral arthritis / Ulnar nerve entrapment / ulnar artery thrombosis | |||
:C = Hook of hamate fracture | |||
:D = Trigger finger | |||
:E = Base of thumb arthritis | |||
==Special Tests== | |||
Special Tests (depends on site of pain, ulnar, radial or mid) | |||
* [[Carpal Instability|Scapholunate instability]] - Watson test | |||
* [[Carpal Instability|Lunotriquetral instability]] – lunotriquetral ballotment test | |||
* DRUJ instability - Compression/ballotment test, Piano key, Drawer | |||
* [[De Quervain Tendinopathy|De Quervain]] - Finklesteins and Eichoffs for | |||
* [[Carpal Tunnel Syndrome]] - Phalens and Tinels | |||
* Radiocarpal and midcarpal drawer tests | |||
* Ulnocarpal stress test | |||
* ECU subluxation | |||
* 1st CMC OA – CMC grind test, shuck test, see progressive adduction with hyperextension | |||
===Tendons=== | |||
===Neurological Exam=== | |||
== Paediatric Examination == | |||
A consensus approach to the MSK examination in children was developed by Foster et al in 2011.<ref>{{#pmid:21954040}}</ref> The <u>underlined</u> components are those that are additional to the adult examination The ''italicised'' components are those that the doctor should be aware of but not necessarily competent in. | |||
* Look at the hands (palms and backs) for muscle wasting, joint swelling, skin and nail changes | |||
* Feel for radial pulse, tendon thickening and bulk of thenar and hypothenar eminences | |||
* Feel for skin temperature | |||
* Squeeze metacarpophalangeal joints (MCPJs) | |||
* Bimanually feel /palpate small joints of the hands including wrists and especially if there are swollen or painful joints or restricted movement noted) | |||
* Look and feel along ulnar border | |||
* Assess full finger extension and full finger tuck | |||
* Assess wrist flexion and extension, abduction and adduction – active and passive | |||
* Assess function: grip and pinch, picking up small object, <u>writing / drawing</u> | |||
* <u>Option – hypermobility syndromes, muscle power, capillaroscopy, peripheral nerves</u> | |||
== References == | |||
[[Category:Examination]] | |||
[[Category:Hand and Wrist]] |
Latest revision as of 15:17, 13 March 2022
This article is a stub.
Inspection
- Expose both limbs to the elbow
- All aspects
- Don’t forget forearm or ulna aspects
- Seated, hands on pillow or desk
- Posture/alignment
- Tremor
- Swelling
- Colour
- Wasting
- Scars
Movement
- Wrist
- Observe supination/pronation rhythm as you inspect
- Flexion/extension
- Radial/ulnar deviation
- Pronation/supination
- Fingers
- Flexion/Extension
- MCPJs – 0-90°
- PIPJs – 0-110°
- DIPJs – 0-90°
- Abduction/Adduction
- Thumb
- Adduction, abduction, opposition, flexion, extension
- Note any hypermobility and skin hyperextensibility.
Palpation
Assess landmarks for tenderness, swelling (ganglions, dactylitis, synovitis, bone or soft tissue), temperature, vasomotor, and sudomotor changes.
Landmarks
Dorsal Wrist Pain
- A = Intersection syndrome
- B = De Quervain’s tenosynovitis
- C = Scaphoid fracture / Wartenbergs syndrome (nerve entrapment)
- D = Base of thumb arthritis
- E = Ulnar collateral ligament injury
- F = Carpal boss
- G = Scapholunate ligament tear
- H = Keinbock’s disease
- I = Lunotriquetral ligament tear
- J = DRUJ (distal radioulnar joint) arthritis / instability
- K = Ulnar impaction / TFCC tear
- L = ECU dislocation / tendonitis
Volar Wrist Pain
- A = FCU tendonitis
- B = Pisiotriquetral arthritis / Ulnar nerve entrapment / ulnar artery thrombosis
- C = Hook of hamate fracture
- D = Trigger finger
- E = Base of thumb arthritis
Special Tests
Special Tests (depends on site of pain, ulnar, radial or mid)
- Scapholunate instability - Watson test
- Lunotriquetral instability – lunotriquetral ballotment test
- DRUJ instability - Compression/ballotment test, Piano key, Drawer
- De Quervain - Finklesteins and Eichoffs for
- Carpal Tunnel Syndrome - Phalens and Tinels
- Radiocarpal and midcarpal drawer tests
- Ulnocarpal stress test
- ECU subluxation
- 1st CMC OA – CMC grind test, shuck test, see progressive adduction with hyperextension
Tendons
Neurological Exam
Paediatric Examination
A consensus approach to the MSK examination in children was developed by Foster et al in 2011.[1] The underlined components are those that are additional to the adult examination The italicised components are those that the doctor should be aware of but not necessarily competent in.
- Look at the hands (palms and backs) for muscle wasting, joint swelling, skin and nail changes
- Feel for radial pulse, tendon thickening and bulk of thenar and hypothenar eminences
- Feel for skin temperature
- Squeeze metacarpophalangeal joints (MCPJs)
- Bimanually feel /palpate small joints of the hands including wrists and especially if there are swollen or painful joints or restricted movement noted)
- Look and feel along ulnar border
- Assess full finger extension and full finger tuck
- Assess wrist flexion and extension, abduction and adduction – active and passive
- Assess function: grip and pinch, picking up small object, writing / drawing
- Option – hypermobility syndromes, muscle power, capillaroscopy, peripheral nerves