Approach to the Hand Examination Karen Booth. Topics for Discussion Review of Anatomy History...
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Transcript of Approach to the Hand Examination Karen Booth. Topics for Discussion Review of Anatomy History...
• Mechanism of injury• Timing, Pain• Motor/sensory deficits
•Constitutional symptoms
• Hand Dominance•Occupation, hobbies, ADLs
• PMHx:•Tetanus status, Allergies•Systemic disease (DM, CTD)
History
1. Bones/Joints:
•LOOK/Inspection•SEADS
•FEEL/Palpation
•MOVE/ Range of Motion•Active•Passive
Physical Examination*compare both sides*
2. Vascular:
• Colour, temperature
•Pulses
•Capillary Refill
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
Physical Examination*compare both sides*
3. Nerves: Motor• Extrinsic
•Median:DIP flexion of index finger (FDP)
•Ulnar:DIP flexion of 5th finger (FDP)
•Radial: Extension of wrist/thumb (ECR/EPL)
Physical Examination*compare both sides*
3. Nerves: Motor• Intrinsic
•Median: Thumb abduction (APB)
•Ulnar: Interossei-DAB-PAD
•Radial: none!
Physical Examination*compare both sides*
3. Tendons:
• Flexor Digitorum Profundus (FDP): flex DIP
• Flexor Digitorum Superficialis (FDS): flex PIP
• Extensor Digitorum Communis (EDC): extension
Physical Examination*compare both sides*
3. Tendons:
Physical Examination*compare both sides*
MCP PIP DIP
Extensor Tendons
EDC EDC (lat bundles)
Intrinsic Muscles
Flexor Tendons
Lumbrical Muscles
FDS FDP
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
Case #1
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
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/extensionPIP: N flexion of PIP = FDS intactDIP: absence of flexion of DIP
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
Case #1: laceration to index finger
RFA: painful swollen joints in hands
• History:
• Physical:•Bones/Joints:
• Inspection: SEADS
• Feel:
• Move:
Case #2
Case #2 Common arthritic findings in the hand
Joint OA RA
DIP ++ Rare
PIP + ++
MCP Rare ++
Wrist Rare ++
Case #2 Common arthritic findings in the hand
•RA: • subluxation of MCP
• radial deviation of wrist
• ulnar deviation of the fingers
Common Deformities in the Hand
•Boutonniere:
• hyperextended DIP and flexed PIP
• central slip of extensor tendon insertion into middle phalanx
Common Deformities in the Hand
•Swan Neck:
• flexed DIP and hyperextended PIP
•PIP volar plate injury
Common Deformities in the Hand
•Mallet Finger:
•DIP in flexion with loss of extension
•due to damage to extensor tendon