OnExam

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)
      • Inflammation (RA)
    • 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)
      • Bouchard's nodes (OA)
    • Distal interphalangeal joints (DIP)
      • Heberden's nodes (OA)
    • 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

  1. 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.
  2. Bickley, L. (2013). Bates Guide to Physical Examination and History Taking. 11th ed. New York: Lippincott Williams & Wilkins; 2013.
  3. Filate, W., Leung, R., Ng, D. & Sinyor, M. (2005). Essentials of Clinical Examination Handbook. 5th ed. Toronto, ON. University of Toronto; 2005.