Oct 02, 2015 osteoarthritis of the fingers, heberdens nodes everything you need to know dr. This is repeated placing the back of the hands together and testing flexion fig. To do so, it is nec essary to understand the functional anatomy of the hand. Examination of the hand and wrist this video describes the anatomy of the hand and wrist and procedures for diagnosing and treating several common pathologic conditions that. Hand and wrist kevin deweber, md, faafp primary care sports medicine. Dec 18, 2015 if a tendon injury or dislocation is suspected, xray examination of the hand should be performed to rule out associated fractures. This hand examination osce guide provides a clear step by step approach to examining the hand, with an included video. This is followed by the basic examination strategy of look inspection, feel palpation, and move range of motion. Orthopaedicrheumatological hand and wrist examination. Key aspects of the wrist and hand exam include inspection, palpation for tenderness or deformity, testing the. The scaphoid bone is the most commonly fractured bone of the wrist, frequently broken by falling on to an outstretched hand. Hand, wrist, and forearm symptoms in the workforce are common problems presented to health care providers and are among the five most common causes of reported workrelated health symptoms and workers compensation claims. Summarise and suggest further investigations you would do after a full history.
The purpose of the examination of the hand, wrist and forearm. Clinical examination of the wrist, thumb and hand c h a p t e r 2 0 323 thumb the extensor pollicis longus and extensor pollicis brevis fig. Physical examination is derived from anatomic knowledge. However, success in treating the patient with hand dysfunction is closely associated with the therapists understanding of essential anatomic and pathokinesiologic principles and the related ability to adequately evaluate, plan, and perform. The hand and wrist is a series of complex, delicately balanced joints.
Patient rated wristhand evaluation the questions below will help us understand how much difficulty you have had with your wristhand in the past week. If you continue browsing the site, you agree to the use of cookies on this website. Examination of the hand and wrist pdf medical books. Observation and range of motion how the patient uses and holds the hand and wrist will give important clues as to the degree of pain and disability. According to 2010 us census data, there was an incidence rate of 67. Examination of the hand and wrist by raoul tubiana and a great selection of similar new, used and collectible books. Juma orthopaedics department slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. Palpate the dorsal surface of the wrist with both thumbs, supporting the joint underneath with. Thank the patient tell them they can get dressed now offer to examine the joint above and the joint below consider neurological examination of the limb examined the complete examination of the musculoskeletal system includes.
Patient may withdraw hand with pain apprehension test o must compare to opposite wrist. The hand and wrist have a total of 27 bones arranged to roll, spin and slide. Hand and wrist examination inspection swelling erythema palmar erythema associated with portal hypertension, chronic liver disease, pregnancy, rheumatoid arthritis, thyrotoxicosis, etc. Evidencebased examination of the elbow, wrist and hand. Wrist course american society for surgery of the hand. Hand dominance, prior hand injury, and prior hand surgeries should be documented. Examination of the hand and wrist examination of the elbow examination of the shoulder examination of the spine examination of the hip examination of the knee examination of the ankle and foot. A thorough history, a systematic examination, and knowledge of disease processes that affect the hand minimize the exam iners diagnostic dilemmas. History, including relevant past history, family history, lifestyle, and other.
Click download or read online button to get examination of the hand and wrist book now. Examination of the hand and wrist examination of the elbow. Instruct the patient to make a fist with the thumb inside the fingers, deviating the wrist to the ulnar side. Deformity conditions dupuytrens disease, congenital conditions 2. It is the most active portion of the upper extremity. Hand and wrist examination frequently appears in osces, often involving patients with osteoarthritis oa or rheumatoid arthritis ra. Some of these include liver disease terrys nails, kidney disease lindsays nails, lung disease nail clubbing, endocarditis and many others. Hand and wrist usually appear normal, but may show thenar atrophy provocative tests. This is a stepbystep instructional video for hand and wrist examination. Examination of the hand introduction examination of the hand is always diseasespecific.
Centraldorsal region christos karagiannopoulos, pt, phd, atc, cht assistant professor, desales university doctor of physical therapy program. Request pdf examination of the wrist and hand the wrist and hand form a highly complex organ that is of great importance in almost all daily activities. Examination of the hand, wrist and forearm february 19, 2004 the purpose of the shoulder and elbow is to position the hand physical examination is derived from anatomic knowledge superficial anatomy anatomic snuff box extensor pollicis. Hand and wrist exam finger hand free 30day trial scribd. The hand and wrist examination, along with all other joint examinations, is commonly tested on in osces.
Osteoarthritis of the fingers, heberdens nodes everything you need to know dr. Hand rehabilitation is an area with the potential for providing orthopaedic physical therapists a challenging and rewarding practice. Musculoskeletal examination of the elbow, wrist, and hand. Athletic injury examination specialstress tests for the. Hand and wrist examina tion inspection swelling erythema palmar erythema associated with portal hypertension, chronic liver disease, pregnancy, rheumatoid arthritis, thyrotoxicosis, etc.
Examination of the hand and wrist by raoul tubiana, available at book depository with free delivery worldwide. By doing this one can observe not only movement but also the limit due to pain. A boggy swelling may signify the presence of synovitis or an effusion. Understand the imperative patient history elements of a elbow, wrist, and hand examination and identify which patient history components are affiliated with common pathologies. Pdf knowledge of anatomy is a necessary prerequisite to assess and plan the means and methods to deal with traumatic wrist injuries. When abnormalities exist, palpate for tenderness and observe active movement, and examine resisted and then passive movement, of each joint. A hand and wrist examination done in a structured manner will lead to a. Pdf overview of wrist and hand orthopaedic special tests. It is important to realize that there are few studies that evaluate patients with workrelated hand, wrist, and forearm disorders.
Nerves examination of the hand should include an assessment of nerve function. Understand the complex anatomy of the ulnar side of the wrist and apply that understanding to be able to perform and accurate and detailed physical examination. The hand should be free to hang over the table edge. This site is like a library, use search box in the widget to get ebook that you want. Resisted flexion resistance is applied to the palmar aspect of the distal phalanx. It is designed for medical students, residents and rheumatology fellows, but would also hand and wrist examination. Examination of the wrist and hand is best done following a stepwise approach, with the patient in a sitting position. Proximal region of the hand is the carpus wrist the middle region the metacarpus palm the distal region the phalanges fingers. Physical exam table 1 offers a quick reference guide for use when performing muscle and tendon function evaluation of the hand and wrist.
Youll be expected to pick up the relevant clinical signs using your examination skills. Chad cook, users will evaluate the impact and prevalence of elbow, wrist, and hand dysfunction. Treat common and uncommon, straightforward and complex, disorders of the ulnar side of the wrist. The dvd details the superficial structures of each body part that must be evaluated to determine the. The exam should begin with inspection, looking for asymmetry between the involved and uninvolved wrist and hand. Consider beginning all physical examinations by reaching for the patients right hand with both of yours. This video aims to give you an idea of how to carry out a comprehensive hand and wrist examination in an osce setting, including tinels test and phalens test. The hand examination stanford medicine 25 stanford. The examination of all joints follows the general pattern of look, feel, move and. Position sitting on side of bed with upper limbs exposed and hands resting on a pillow.
Wristhand physical examination name date wristhand inspection finding positive mass swelling discoloration deformity cicatrix joint play bony palpation soft tissue palpation passive range of motion wristhand norm exam pain flexion 80 extension 70 medial deviation 20 lateral deviation 45 active range of motion wristhand norm exam pain. Hand and wrist examination musculoskeletal osce skills. Apply resistance to the thumbs while prompting the patient to move them towards the ceiling. Jul 19, 2015 examination arom, then prom with over pressure the gross motions of wrist, hand, finger and thumb flexion, extension, and radial and ulnar deviation are tested, first actively and then passively any loss of motion compared with the contralateral, asymptomatic wrist and hand should be noted 45. A free powerpoint ppt presentation displayed as a flash slide show on id.
Understand the imperative patient history elements of a elbow, wrist, and hand examination and identify which patient history components are. You will be describing your average wristhand symptoms over the past week on a scale of 010. Wrist and hand examination and interpretation jospt. Examination of the hand and wrist download ebook pdf, epub. Examination of the hand and wrist download ebook pdf. Part two2 focuses on the emergent evaluation of hand and wrist. Inspect the wrist for erythema, swelling, deformity and muscle wasting.
If a tendon injury or dislocation is suspected, xray examination of the hand should be performed to rule out associated fractures. The physical examination of the wrist is not unlike other joints, in that a systematic approach includes observation, range of motion, palpation and special tests. Wristhand physical examination back to chiropractic. Clinical examination of the hand is a basic skill that both the surgeon and the therapist should master. You should ensure you are able to perform this confidently. Physical examination based upon the interpretation of information obtained from the patient history, a plan for the physical examination pe is formulated.
Wrist and hand examination and interpretation journal of. Clinical examination of the wrist, thumb and hand c h a p t e r 2 0 323 thumb the extensor pollicis longus and extensor pollicis brevis fig examination of the hand and wrist pdf. An understanding of the basic functional anatomy of the hand is essential for examination, accurate diagnosis, and successful treatment of disorders of the hand. The ex aminer selects the method, technique, and pro. Remembering that the hand and wrist examination will take in and appreciate that. The system to be examined is derived based on the primary survey. Atrophy thenar and hypothenar interossei muscles dupuytrens contracture o caused by thickening and puckering of the palmar fascia. Examination arom, then prom with over pressure the gross motions of wrist, hand, finger and thumb flexion, extension, and radial and ulnar deviation are tested, first actively and then passively any loss of motion compared with the contralateral, asymptomatic wrist and hand should be noted 45. Stabilization of lunate with one hand shifting scaphoid in volardorsal direction with other hand. A hand and wrist examination done in a structured manner will lead to a correct diagnosis.
Scaphoid impingement with wrist extension listers tubercle prominence over middorsal distal radius demarks. Examination of the hand and wrist this video describes the anatomy of the hand and wrist and procedures for diagnosing and treating several common pathologic conditions that affect them, including. This should be followed by palpation of key structures to identify tenderness, swelling, or deformity. The second stage is a more focused examination of one or more specific systems limited to the involved hand. The examination of the hand and nails can lead to a number of diagnoses. Musculoskeletal examination of the elbow, wrist and hand. The anatomy of wrist, thumb and hand is complex because of the presence of many different functional joints. Perform a systematic examination, documenting and organizing the results well. Centraldorsal region christos karagiannopoulos, pt, phd, atc, cht. To complete exam to complete my examination i would examine the joint above, and also do a full neurovascular exam would you like me to do this now. Standard terminology should be used when describing the anatomy and motion of the hand and wrist. In other words the site and nature of the pain or deformity will determine your approach to the examination.