Hand Examination - Revision Card

WIPER

Look
Inspect dorsum of hands for muscle wasting, skin and nail changes/swelling
Can you turn your hands over for me?
Check wrist for carpal tunnel release
Put hands on shoulders? - check elbows

Okay - you can put them back on the pillow

Feel
Skin
- Temperature
- Presence of nodules/plaques at elbows
- Tendon thickening

Joints/Bone
Pain in your hands?
- Squeeze MCPs
- Bimanually palpate swollen/painful joints, incluiding wrist

Nerves
- Radial Nerve - pulse, first web-space
Turn your hands over?
- Median Nerve - thenar eminence bulk, lateral index finger sensation
- Ulnar Nerve - hypothenar eminence bulk, medial aspect of medial fingers
*tendon thickening

Move
Wrist flexion and extension (prayer and inverse prayer sign)
Thumb opposition/abduction
Full finger extension and full finger tuck (extensor tendon ramage, joint damae, neuro damage
Finger adduction/abduction

Function
- grip power 
- pincer grip
- pick up small object

Carpel Tunnel Syndrome?
Tinel's Test
Phalen's Test (60s)
Old Synovitis
Thick, rubbery, non-tender
Active synovitis
Thick, rubbery, effusion, warm, swollen, tender