The Purpose of the

Shoulder and Elbow

is to position
The HAND

Examination of the Hand,

Wrist and Forearm
February 19, 2004

Physical Examination is derived

from Anatomic Knowledge

Superficial Anatomy
n

Anatomic Snuff Box

n
n
n

Extensor Pollicis Brevis

Extensor Pollicis Longus
Palpate Scaphoid

Superficial Anatomy
Superficial Anatomy
Palpate
n
n

Distal Radius
Distal Ulna

Metacarpophalangeal
Joint (MCP)
Proximal
Interphalangeal Joint
(PIP)
Distal Interphalangeal
Joint (DIP)

Superficial Anatomy

Vascular Anatomy
n
n
n
n

Radial Pulse
Ulnar Pulse
Allen Test

Superficial Anatomy
n

Superficial Anatomy

Extensor Digitorum Communis

n

Superficial Anatomy

Thumb Extensor Tendons

3 Joints = 3 Tendons

Flexor Carpi Ulnaris

n
n

Flexor Carpi Radialis

Palmaris Longus
n

May not be present

Palpate tendon
Can you palpate the
pisiform ?

Bouchard Node

Heberden Node
n

Osteoarthritic Marginal Osteophytes

involving the Distal InterInter-Phalangeal Joint
(DIP)

Osteoarthritis with Marginal Osteophytes

at Proximal InterInter-Phalangeal Joint (PIP)

Provocative Tests
Carpal Tunnel Syndrome
n
n

Provocative Test
De Quervain Tenosynovitis

Phalen Maneuver
Tinel Sign over Median
Nerve

Range of Motion

Range of Motion
n

Forearm Rotation
n
n

Pronation
Supination

Finkelstein Maneuver

Wrist
n
n

Flexion = Palmar Flexion

Extension = Dorsi Flexion

Range of Motion
Range of Motion
n

Wrist
n

Thumb
n

CMC
n

Radial Deviation
toward the radius
Ulnar Deviation
toward the ulna

MP
n
n

Range of Motion
Finger
n

n
n
n
n

n
n
n

TwoTwo-point discrimination
n

n
n

Distributions of nerves
to hand
Radial
Median
Ulnar

Flexion
Extension

Physical Examination
n

Sensory function
n

Flexion
Extension
Abduction
Adduction

PIP & DIP

n

Flexion
Extension

Physical Examination
n

MP

Flexion
Extension

IP
n

Abduction
Adduction

Physical Examination
n

Flexor Digitorum Profundus

Smallest distance that patient can correctly

identify on 2/3 trials
5 mm normal
>15 mm absent

Physical Examination

Physical Examination

Flexor Digitorum Superficialis

Extend all other digits to isolate

FDS and inhibit motion from FDP

Motor exam
n

Median Nerve
nAll

muscles of palmar
forearm except:
nFCU
nFDP
nFDP

ring
little

Physical Examination
n

Motor exam
n

Ulnar Nerve
nAll

muscles of hand except:

nAPB
nOpponens

Pollicis
superficial head
nLumbricals index & middle
nFPB