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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