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Hand & Wrist Examination

From Mediwikis

Read the instructions carefully and examine the correct side, and attend to the patient's comfort. Observe the patients face throughout!

Wash Hands

Introduction, Explanation, Consent

Look

Hands (palms and backs)

  • Muscle wasting
  • Skin and nail changes

Wrist

  • Carpal tunnel release

Feel

  • Radial pulse
  • Tendon thickening
  • Thenar and hypothenar bulk
  • Median, ulnar and radial nerve sensation
  • Skin temperature
    • Symmetry
  • Squeeze MCPs
  • Bimanually palpate painful joints, including wrists
  • Ulnar border

Move

  • Full finger extension and tuck
    • Wrist flexion and extension
    • Active
    • Passive
  • Median and ulnar nerve power

Function

  • Grip and pinch
  • Picking up small object

Phalen's Test

  • Hold wrist in complete and forced flexion (pushing the dorsal surfaces of both hands together) for 30–60 seconds, compressing the median nerve within the carpal tunnel
  • Burning/tingling/numb sensation over thumb, index, middle and ring fingers = +ve test result, suggesting carpal tunnel syndrome

Wash Hands