Exam
Hand Exam
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Hand Exam
, Hand Neurovascular Exam
See Also
Hand Anatomy
Wrist Exam
Wrist Anatomy
Wrist Injury
(Includes summarized exam)
Hand Injury
(Includes summarized exam)
Indication
Hand Injury
Observation
Hand Position of Function
Inability to assume position of function is a red flag
Position of Function Image
Observation
Fixed digital flexion or extension
Fixed single finger extension: Flexor
Tendon Injury
Image
Description: Observe with hand at rest
Affected finger in complete extension
Other fingers PIP and DIP at 10 degrees flexion
Injuries
DIP Flexor Tendon Avulsion
Flexor Tendon Laceration
Fixed single finger flexion: Extensor
Tendon Injury
Image
Injuries
Extensor Tendon Laceration
DIP Extensor Tendon Avulsion
Observation
Finger rotational deformity
Image
Flex finger against palm
Finger tips normally point toward
Scaphoid
Malalignment suggests
Fracture
with rotation
Observation
Skin changes
Vascular compromise signs
Capillary Refill
>2 seconds
Also check radial pulse and ulnar pulse
Consider
Allen Test
for ulnar artery distribution
Digital nerve injury
Two Point Discrimination
requires >5 mm apart
Skin Color
change
Anhidrosis
of finger involved
Blanched or hyperemic
Skin Color
Exam
Brief tendon evaluation
Observe for fixed digital flexion or extension
See above
Extend DIP joint of affected finger
Fails:
DIP Extensor Tendon Avulsion
(
Mallet Finger
)
Start with all fingers in extension
Flex PIP joint of affected finger only
Injury
Flexor digitorum profundus injury (
Jersey Finger
)
Testing
Test with all fingers in extension
Hold affected finger DIP in extension
Patient instructed to flex affected PIP joint
Flex DIP joint of affected finger only
Consider flexor digitorum superficialis injury
Specific test for index finger
Patient pulls a paper between both hands
Paper held by each hand pinching paper
Each hand uses opposed thumb and index finger
Injury of flexor digitorum superficialis signs
DIP hyperflexes
PIP hyperextends
Exam
Brief
Neurologic Exam
ination
Ulnar Nerve
Finger abduction against resistance (hand intrinsic muscles)
Sensation to ulnar 1.5 fingers on palmar aspect (e.g. tip of pinky finger or hypothenar eminence)
Median Nerve
Sensation to radial 3.5 fingers and dorsal tips (e.g. tip of index finger or thenar eminence)
Oppose thumb to index finger against resistance
Median Nerve
is "british" (the tea drinking nerve)
Controls pincher grasp (with thumb and index), elbow flexors and pronators, wrist flexors
Mallon (2018) CCME Emergency Board Exam
Radial Nerve
Wrist
extension (dorsiflexion) against resistance (as well as extension at the elbow and fingers)
Sensation to dorsal first 3.5 fingers (e.g. dorsal first web space)
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