Transcript Hand Examination - Peggers Super Summaries

James Pegrum (Peggers)
MB BS BSc MSc MRCS Diploma (IKAR,IUAA,ISMM)
Overview
 Hand Anatomy
 Hand Examination
 Wrist & Arm X Rays
Hand Anatomy
Hand Anatomy – carpal bones
 “Some Loves Try
Positions That
They Can’t Handle”
Hand Anatomy – Carpal Tunnel
 Draw the carpal tunnel
incision on each other
Hand Examination Overview
 Look Systemically
 Look Locally
 Feel
 Move
 Special Tests
 Function
look Systemically
Look Locally
 Finger Nails
 Clubbing
 Pitting
 Onycholysis
 Dorsum
 Guttering
 Bruising
 Scars
 Palmar
 Dupytrens
 Thenar wasting
 Scars
 Joints
 Heberdens nodes
DIP
 Bourchard’s nodes
PIP
 Deformity
Look Locally
Look
Look
Look
OA vs RA
OA
RA
Skin
N
May be thin bruised – steriods
Erythema
Soft tissues
Wasting of muscles
Muscle wasating
Synovitis around joints
Warm & Tender
Bone
DIPJ
Bilateral diffuse PIPJ
Defomity
Squaring of the palm
Joint subluxation DIPJ
Ulnar deviation fingers
Radial deviation wrist
Z deformity of thumb
Swan neck & boutonierre
Look – Nails
Look
Peggers Top Tip
 A Rheumatoid patient what you need to tell the
examiner………
 Active or inactive disease? How do you tell?
 If the patient is rheumatoid factor positive? How do you
tell?
Look
Look
Peggers Top Tip
 When looking for a tendon injury place elbows on
table/knee wrists flexed and finger pointing to each
other……….
 Simple ask patient to extend the wrist and watch for
the cascade
Look
Look
Feel
 Tenderness
 Temperture
 Swelling
 Bogginess
Move
 Finger cascade
 Precision Grip
 Fist and note strength
 Supination / Pronation
Special Tests
 Carpal Tunnel
 De Quervain’s
 Flexor Tendons
 Neurological
Carpal Tunnel
 Tinels’ Tap Test
 Phalens Test
De Quervain’s
 Tests for tenosynovitis /
Tendinopathy
Flexor Tendons
 FDP
 FDS
Neurological – Median Nerve
 Look
 Thenar muscle wasting
 Carpal tunnel scar
 Wrist laceration from self harm
 Feel
 Radial 3 ½ fingers
 Test
 “O Sign” thumb and Index finger
Neurological – Ulnar Nerve
 Look
 Hypothenar muscle wasting
 Wrist and elbow scars
 Feel
 Ulnar 1 ½ fingers
 Test
 Abduct and adduct fingers
Neurological – Radial Nerve
 Look
 Wrist drop
 Scars around humerus
 Feel
 Dorsal 1st web space
 Test
 Wrist extension – “stop sign”
 Thumbs up
Functions – Day to day living
 Hold pen and write
 Keys
 Buttons on Shirts
 Stand from sitting
Summary
 Systemic Features
 Face
 Look
 Nails, Dorsum, Palmar, Joints
 Feel
 Tenderness, Swelling, Temperature, Bogginess
 Move
 Finger cascade, Precision, Fist, Supination/Pronation
 Special Tests
 Carpal tunnel, De Quervain’s , Flexors, Neurological
 Functions
 Pen, Keys, Buttons, Standing
X - Rays
Common Fractures
Common Fractures
What you have learnt
 Hand Anatomy
 Hand Examination
 Common X Rays
Thank you
 This lecture and teaching materials can be found on
the following website
 www. peggers super summaries . com (all 1 word)
 www.peggerssupersummaries.com