Hand exam

Background

Must exam tendon injuries in their entirety through full range of motion
- Injuries with digits in flexion may cause retraction of cut end of tendon when examined in neutral position
All exams should include a thorough history of events

General appearance
Palpate for: Crepitus, deformity, joint tenderness, rotation deformity, snuffbox tenderness

Bilateral grip strength
Have patient make a clenched fist
- Observe orientation and rotation of middle and distal phalanxes
- Assess for scissoring (overlapping of digits)
- All phalanges should be oriented parallel to each other with nails in same plane
Have patient draw fingertips together so tip of thumb touches tips of the other 4 digits
- Gross estimation of intact median, ulnar, and radial nerve motor function
Pincer function test
- Weakness suggests median nerve or ulnar collateral ligament disruption

Must test with resistance
Pain along course of tendon during resistance testing suggests partial rupture
Flexor digitorum profundus (FDP)
- Flex DIP against resistance while MCP and PIP joints are held in extension
Flexor digitorum superficialis (FDS) + Flexor pollicis longus (FPL)
- Flex PIP against resistance while remaining fingers are held in extension
Extensor tendons
- Hand flat an surface and lift fingers individually

Median
- Controls thumb opposition and 1st and 2nd lumbricals
- Have patient touch tip of thumb to tip of little finger with a paper in between. Pull paper away.
- Sensation to distal 2nd digit

Ulnar
- Controls thumb adduction and 3 and 4th lumbricals
- Have patient spread the fingers apart against resistance
- Interpose a tongue deppressor between thumb and index finger and try to pull radially
- Sensation to distal 5th digit

Radial
- Controls thumb and wrist extension
- Have patient make "thumbs up" while hand is
- Sensation over the dorsal web space between the 1st and 2nd digits