The Purpose of the
Shoulder and Elbow
is to position
The HAND
Examination of the Hand,
Wrist and Forearm
February 19, 2004
Physical Examination is derived
from Anatomic Knowledge
Superficial Anatomy
n
Anatomic Snuff Box
n
n
n
Extensor Pollicis Brevis
Extensor Pollicis Longus
Palpate Scaphoid
Superficial Anatomy
Superficial Anatomy
Palpate
n
n
Distal Radius
Distal Ulna
n
n
n
Metacarpophalangeal
Joint (MCP)
Proximal
Interphalangeal Joint
(PIP)
Distal Interphalangeal
Joint (DIP)
1
Superficial Anatomy
Vascular Anatomy
n
n
n
n
Radial Pulse
Ulnar Pulse
Allen Test
n
Superficial Anatomy
n
Superficial Anatomy
Extensor Digitorum Communis
n
Superficial Anatomy
n
Thumb Extensor Tendons
3 Joints = 3 Tendons
Flexor Carpi Ulnaris
n
n
Flexor Carpi Radialis
Palmaris Longus
n
May not be present
Palpate tendon
Can you palpate the
pisiform ?
2
Bouchard Node
Heberden Node
n
Osteoarthritic Marginal Osteophytes
involving the Distal InterInter-Phalangeal Joint
(DIP)
n
Osteoarthritis with Marginal Osteophytes
at Proximal InterInter-Phalangeal Joint (PIP)
Provocative Tests
Carpal Tunnel Syndrome
n
n
Provocative Test
De Quervain Tenosynovitis
Phalen Maneuver
Tinel Sign over Median
Nerve
n
Range of Motion
Range of Motion
n
Forearm Rotation
n
n
Pronation
Supination
Finkelstein Maneuver
n
Wrist
n
n
Flexion = Palmar Flexion
Extension = Dorsi Flexion
3
Range of Motion
Range of Motion
n
n
Wrist
n
n
Thumb
n
CMC
n
Radial Deviation –
toward the radius
Ulnar Deviation –
toward the ulna
n
n
MP
n
n
n
n
Range of Motion
Finger
n
n
n
n
n
n
n
n
n
n
TwoTwo-point discrimination
n
n
n
Distributions of nerves
to hand
Radial
Median
Ulnar
Flexion
Extension
Physical Examination
n
Sensory function
n
Flexion
Extension
Abduction
Adduction
PIP & DIP
n
Flexion
Extension
Physical Examination
n
MP
Flexion
Extension
IP
n
n
Abduction
Adduction
Physical Examination
n
Flexor Digitorum Profundus
Smallest distance that patient can correctly
identify on 2/3 trials
5 mm normal
>15 mm absent
4
Physical Examination
Physical Examination
Flexor Digitorum Superficialis
n
n
Extend all other digits to isolate
FDS and inhibit motion from FDP
n
Motor exam
n
Median Nerve
nAll
muscles of palmar
forearm except:
nFCU
nFDP
nFDP
ring
little
Physical Examination
n
Motor exam
n
Ulnar Nerve
nAll
muscles of hand except:
nAPB
nOpponens
Pollicis
superficial head
nLumbricals index & middle
nFPB
5