Hand Neurovascular Exam

Aka: Hand Neurovascular Exam, Hand Neurologic Exam, Hand Vascular Exam

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II. Exam: Vascular

  1. Capillary Refill (normal <2 seconds)
  2. Radial pulse
  3. Ulnar pulse
  4. Allen Test
    1. Indicated if concerns regarding radial artery or ulnar artery deficit)

III. Exam: Neurologic

  1. Ulnar Nerve
    1. Finger abduction against resistance (hand intrinsic Muscles)
    2. Sensation to ulnar 1.5 fingers on palmar aspect (e.g. tip of pinky finger or hypothenar eminence)
  2. Median Nerve
    1. Sensation to radial 3.5 fingers and dorsal tips (e.g. tip of index finger or thenar eminence)
    2. Oppose thumb to index finger against resistance
      1. NeuroMedianNerve.jpg
      2. Median Nerve is "british" (the tea drinking nerve)
        1. Controls pincher grasp (with thumb and index), elbow flexors and pronators, wrist flexors
        2. Mallon (2018) CCME Emergency Board Exam
  3. Radial Nerve
    1. Wrist extension (dorsiflexion) against resistance (as well as extension at the elbow and fingers)
    2. Sensation to dorsal first 3.5 fingers (e.g. dorsal first web space)
      1. NeuroRadialNerve.jpg
  4. Other Specific Nerves
    1. Digital nerve injury
      1. Two Point Discrimination requires >5 mm apart
      2. Skin Color change
        1. Anhidrosis of finger involved
        2. Blanched or hyperemic Skin Color
    2. Anterior Interosseous Nerve (Volar Interosseous Nerve)
      1. Median Nerve branch supplies deep flexor Muscles of the anterior Forearm
      2. Does not innervate ulnar aspect of flexor digitorum profundus
    3. Posterior Interosseous Nerve (Dorsal Interosseous Nerve)
      1. Radial Nerve branch supplies deep extensor Muscles of the posterior Forearm

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