Hand examination

 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

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

• 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.