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Approach to the Hand Examination

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Approach to the Hand Examination Karen Booth Topics for Discussion Anatomy Approach to the Hand Examination Topics for Discussion Anatomy Review of Anatomy History ... – PowerPoint PPT presentation

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Title: Approach to the Hand Examination


1
Approach to the Hand Examination
Karen Booth
2
Topics for Discussion
  • Review of Anatomy
  • History
  • Physical Examination
  • Cases

3
Anatomy
  • Bones/Joints
  • Muscles
  • Nerves
  • Tendons
  • Vascular

4
History
  • Mechanism of injury
  • Timing, Pain
  • Motor/sensory deficits
  • Constitutional symptoms
  • Hand Dominance
  • Occupation, hobbies, ADLs
  • PMHx
  • Tetanus status, Allergies
  • Systemic disease (DM, CTD)

5
Physical Examination compare both sides
  • 1. Bones/Joints
  • LOOK/Inspection
  • SEADS
  • FEEL/Palpation
  • MOVE/ Range of Motion
  • Active
  • Passive

6
Physical Examination compare both sides
  • 2. Vascular
  • Colour, temperature
  • Pulses
  • Capillary Refill

7
Physical Examination compare both sides
  • 3. Nerves Sensory
  • Median pulp of index finger
  • Ulnar pulp of 5th digit
  • Radial 1st dorsal webspace
  • Digital Nerves 2 point discrimination

8
Physical Examination compare both sides
  • 3. Nerves Motor
  • Extrinsic
  • MedianDIP flexion of index finger (FDP)
  • UlnarDIP flexion of 5th finger (FDP)
  • Radial Extension of wrist/thumb
  • (ECR/EPL)

9
Physical Examination compare both sides
  • 3. Nerves Motor
  • Intrinsic
  • Median Thumb abduction (APB)
  • Ulnar Interossei
  • -DAB
  • -PAD
  • Radial none!

10
Physical Examination compare both sides
  • 3. Tendons
  • Flexor Digitorum Profundus (FDP) flex DIP
  • Flexor Digitorum Superficialis (FDS) flex PIP
  • Extensor Digitorum Communis (EDC) extension

11
Physical Examination compare both sides
  • 3. Tendons

12
Case 1
  • RFA laceration to index finger
  • History
  • MOI kitchen knife, vegetables
  • Location R side, palmar, distal to PIP jt
  • Occupation office, Hobby instrument
  • Handedness R, dominant
  • PMHx NKDA, tetanus UTD
  • no systemic disease

13
Case 1 laceration to index finger
  • Examination Compare both sides
  • Bones/Joints
  • Look/Feel/Move joint above/below injury
  • No swelling, painful in area
  • Normal PIP flexion extension
  • Difficulty with flexion of DIP
  • Vascular
  • Good colour/temperature
  • Normal Pulses
  • Normal capillary refill

14
Case 1 laceration to index finger
  • Examination Compare both sides
  • Neuromuscular
  • Sensory N median, ulnar, radial, digital nerves
  • Motor N intrinsic fxn
  • Tendons
  • MCP jt N flexion/extension
  • PIP N flexion of PIP FDS intact
  • DIP absence of flexion of DIP

15
Case 1 laceration to index finger
  • Diagnosis
  • injury to FDP of index finger
  • Management
  • Clean area, irrigate with NS, apply sterile
    dressing
  • Antibiotic Prophylaxis, tetanus if necessary
  • X-Ray r/o fracture
  • Plastics
  • operative primary repair of tendon within 14 days

16
Case 2
  • RFA painful swollen joints in hands
  • History
  • Physical
  • Bones/Joints
  • Inspection SEADS
  • Feel
  • Move

17
Case 2 Common arthritic findings in the hand
18
Case 2 Common arthritic findings in the hand
  • RA
  • subluxation of MCP
  • radial deviation of wrist
  • ulnar deviation of the fingers

19
Common Deformities in the Hand
  • Boutonniere
  • hyperextended DIP and flexed PIP
  • central slip of extensor tendon insertion into
    middle phalanx

20
Common Deformities in the Hand
  • Swan Neck
  • flexed DIP and hyperextended PIP
  • PIP volar plate injury

21
Common Deformities in the Hand
  • Mallet Finger
  • DIP in flexion with loss of extension
  • due to damage to extensor tendon

22
Case 3 Common Problems in the Hand
  • Trigger finger/stenosing tenosynovitis
  • inflammation of synovium causing friction between
    flexor tendon and pully sheath
  • locking of finger with flex/ext
  • palpable nodule over MCP
  • painful
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