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Hand examination

LOOK

 Expose the whole forearm & hand.

Look at the:

    • Dorsum, Palm,
    • Muscles - Thenar, Hypothenar, first dorsal interosseus, ADM, FCU (in forearm)
    • Congenital abnormalities
    • Open & close hand to quickly assess mass movement of the hand

FEEL

  • - ask for & feel the tender area
  • -  muscles
  • - swellings
  • Palmar fascia & 1st web space (for nodules)

MOVE

  • Make a fist (active mass motion)
  • Thumb:
    •  Opposition to all fingers in turn
    •  Adduction, Abduction, Flexion
    •  EPL = tested by asking patient to lift thumb up off a table whilst hand held palm down on table
  • EDC - extend fingers at MCPJ's
  • Interossei - Ask patient to abduct fingers (dorsal interossei); ask patient to adduct fingers (palmar interossei)
  • FDS - individually tested by holding other fingers in hyperextension
  • FDP - tested by fixing the PIPJ & thus isolating the DIPJ
  •  Quadriga phenomenon  (a Quadriga = an ancient Greek four horse chariot)
    • when testing for FDS the FDP is defunctioned because the FDP tendons are combined, while the FDS muscles are separate in the forearm. 
    • Following repair or reconstruction of an FDP tendon the tension must be identical to the other FDPs, since the excursion of the combined tendons is equal to the shortest tendon.


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