Examination of the hand
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1 Grundkurs SGSM-SSMS Sion 2015 Examination of the hand Dr. S. KŠmpfen
2 Clinical History!! Mechanisms of the trauma!! Pain history (type, intensity, localisation)!! Inflammation!! Deformation!! Mobility!! Co-morbidities
3 Installation!! Comfort!! Seat!! Face to face!! Elbow on table
4 Observation!! How the patient uses and holds the hand and wrist!! Inspection : Wasting of muscles, shiny skin, scars, skin changes
5 Palpation!! Knowledge of anatomy and pathology of the concerned area
6 ANATOMY : Radial dorsal zone!! Bony features palpable "! Radial styloid "! Scaphoid "! Scapho-trapezial joint "! Trapezium "! Base of the first metacarpal
7 Radial wrist examination!! Soft tissues : nerve * Nevralgia of lateral antebrachial cutaneous nerve / superficial branch of radial nerve
8 Radial wrist examination!! Soft tissues : nerve * Wartenberg Syndrome
9 Radial wrist examination! Soft tissues : tendon * De Quervain Tenosynovitis (Finkelstein test)!
10 Radial wrist examination!! Soft tissues : tendon * Intersection Syndrome
11 Radial wrist examination!! Osteoarticular * TM Arthrosis Compression!
12 Radial wrist examination!! Osteoarticular * STT arthrosis Compression!
13 Radial wrist examination!! Osteoarticular * Scaphoid fracture * Scapholunate instability Snuffbox!
14 ANATOMY : Dorsal wrist!! ListerÕs tubercle!! Scapholunate joint!! Lunate!! Capitate!! Bases of the second and third metacarpals and CMC joints!! Distal aspect of ECRL and ECRB!! EPL and EDC
15 ANATOMY : Dorsal wrist LUNATE "! Distal & ulnar to ListersÕs tb "! More prominent with wrist held in flexion "! Pain in the absence of trauma may indicate idiopatic osteonecrosis (KienbšckÕs disease)
16 ANATOMY : Dorsal wrist SCAPHO-LUNATE JOINT "! Begin palpation on the lunate bone "! Once found, then move wrist into radio and ulnar deviation. "! Tenderness may reveal S-L dissociation "! Occult ganglion may cause chronic wrist pain (more evident in wrist flexion)
17 Dorsal wrist examination!! Ligament * Scapholunate interval
18 Dorsal wrist examination!! Ligament * Scapholunate interval! KienbockÕs disease! SL ligament tears! Chronic occult ganglion
19 Dorsal wrist examination!! Tendon * 4th and 5th extensor compartment! Tenosynovitis (pain, swelling, tenderness)
20 Dorsal wrist examination!! Osteoarticular * Carpometacarpal joints
21 Dorsal wrist examination!! Osteoarticular * Carpometacarpal joints! CMC Sprain! Carpal boss
22 ANATOMY : Ulnar wrist!! Ulnar styloid!! Distal radio-ulnar joint!! Triquetrum!! Hamatum!! Bases of the fourth and fifth metacarpals and CMC joints!! Lunate!! ECU
23 ANATOMY : Ulnar wrist TFCC
24 Ulnar wrist examination!! Tendon * Extensor carpi ulnaris
25 Ulnar wrist examination!! Osteoarticular * Ulnocarpal impaction The grind test for ulnocarpal impaction or TFCC tears.
26 Ulnar wrist examination!! Osteoarticular * TFCC tear The grind test for ulnocarpal impaction or TFCC tears.
27 Ulnar wrist examination!! Nerve * Nevralgia of the ulnar nerve
28 Ulnar wrist examination!! Osteoarticular * Triquetrum
29 Ulnar wrist examination!! Ligament * TFCC
30 ANATOMY : Volar zone
31 ANATOMY : Volar zone
32 ANATOMY : Ulnar volar zone!! Pisiform!! Hook of the hamate!! Ulnar nerve and artery!! Flexor carpi ulnaris tendon
33 ANATOMY : Radial volar zone!! Scaphoid tuberosity!! Tubercle of the trapezium!! Flexor carpi radialis!! Palmaris longus!! Long fingers flexors!! Median nerve
34 ANATOMY : Tendons EXTENSOR TENDONS "! 1st comp. : APL / EPB "! 2nd comp. : ECRL / ECRB "! 3rd comp. : EPL "! 4th comp. : EDC / EIP "! 5th comp. : EDM "! 6th comp. : ECU
35 ANATOMY : Tendons
36 Provocative tests of carpal instability!! Scapholunate instability Scaphoid shift test (Watson)
37 Provocative tests of carpal instability!! Lunotriquetral instability Ballottement test (Reagan) Kleinman's shear test Lateral compression test
38 Provocative tests of carpal instability!! Radiocarpal instability
39 Provocative tests of carpal instability!! Midcarpal instability
40 Provocative tests of carpal instability!! Capitolunate instability
41 Other tests!! Pisiform grinding test! pisiform instability! pisotriquetral arthritis
42 Range of motion Extension (70 ) / Flexion (80 ) Radial (20 ) / Ulnar deviation (40 ) Pronation (70 ) / Supination (90 )
43 Strength!! Dynamometer!! Global strength / pinch thumb-index!! Men "!80 pounds (36 kg) / 60 pounds (27 kg)!! Women "!50 pounds (23 kg) / 30 pounds (14 kg)
44 Thank you for your attention Reference : Physical Examination of the Wrist D. Young, S. Papp, A. Giachino Orthopedic Clinics of North America 38 (2007)
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