Hand and Wrist Examination

Checklist
Wash hands, introduce yourself, consent patient.

LOOK
- Scars, swellings, deformities (Heberdens, Bouchards, Swan neck)
- Muscle wasting
- Positioning (ulnar deviation, claw hand)
FEEL
- Temperature
- Muscle bulk of thenar and hypothenar eminence
- Dupuytren’s contracture
MOVE
- Active, then passive movement and monitor for pain of:
  - DIP joints
  - PIP joints
  - MCP joints
  - Wrist – extension, flexion, ulnar and radial deviation
SPECIAL
- Assess nerves
- Radial
  - Motor – extend fingers (tests ED)
  - Sensory – dorsal surface of first webbed space
- Ulnar
  - Motor – spread fingers against resistance (lumbricals)
  - Sensory – medial edge of 5th finger
- Median
  - Motor – Thumb abduction (out of plane against resistance against APB)
  - Sensory – lateral edge of index finger
- Power grip – grip 2 fingers tightly
- Pincher grip – index and thumb pinches examiners finger
- Observe picking up a coin or other small object

Omissions/Notes

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