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Wrist Hand Checklist2 PDF

This document provides a checklist for examining the wrist and hand during a physical exam. It lists inspection items like muscle bulk, posture, and deformities. Palpation focuses on bones, joints, and tendons for tenderness or injuries. Range of motion is assessed for the wrist and fingers. Neurological tests check sensation, strength, and reflexes. Vascular assessment includes pulses. Functional tests involve grips and special tests like Phalen's and Finkelstein's for conditions like carpal tunnel.

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656 views1 page

Wrist Hand Checklist2 PDF

This document provides a checklist for examining the wrist and hand during a physical exam. It lists inspection items like muscle bulk, posture, and deformities. Palpation focuses on bones, joints, and tendons for tenderness or injuries. Range of motion is assessed for the wrist and fingers. Neurological tests check sensation, strength, and reflexes. Vascular assessment includes pulses. Functional tests involve grips and special tests like Phalen's and Finkelstein's for conditions like carpal tunnel.

Uploaded by

ngurah
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© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Musculoskeletal Wrist and Hand Physical Exam Checklist

Learnpediatrics.com Written by Dr. R. Acedillo

EXAMINATION OSCE ITEMS

SITTING Inspection Muscle Bulk


Posture Thenar eminence
Fingers rested in flexion normally Hypothenar eminence
Wartenburgs sign (5th digit abducted in ulnar Interossei muscles (DAB and PAD!)
injury) Deformities
Clawing (flexion contracture late ulnar injury) Swan neck (RA hyperext PIP, flexed DIP) and
Dupytrens contracture (nodule in palm) Boutenerrie deformities (RA flexed PIP, hyperext
Rotational deformities better with fingers flexed DIP)
(metacarpal and phalangeal deformities) Ulnar drift (as in RA)
Other Mallet finger (flexed DIP b/c of traumatic avulsion of
Inflammation extensor digitorum tendon)
Skin and nails (paronychia, psoriatic pitting, Heberdens nodes (DIP as in OA) and Bouchards
clubbing, splinter hemorrhage, vasculitis in RA) nodes (PIP more as in RA)

Palpation
Skin nodules (as in Dupytrens disease) Tendons
Bone tenderness (fractures or wrist ligament injuries) Extensor pollicis longus (ruptures in RA), abductor
Ulnar and radial styloid (fractures) pollicis longus and extensor pollicis brevis
Listers (dorsal tubercle of radius) and scaphoid (DeQuervains tenosynovitis)
tubercle Extensor tendons on dorsum of hand (commonly
Distal radioulnar joint (tenderness in radial head lacerated or ruptured in RA)
[Exxex-Lopresti lesion]/shaft [Galeazzi] fractures Flexor carpi radialis (often lacerated) and palmaris
Lunate, pisiform, hook of hamate (fractures) longus (landmark for median nerve)
Metacarpals and phalanges (fractures) Finger and thumb flexor tendons (trigger finger,
MP, PIP, and DIP joints (RA, OA, injuries) lacerations, etc)
Anatomical snuff box (scaphoid + trapezius)

Active ROM (if normal passive ROM not done) Tendon Assessment
Wrist Flexor digitorum superficialis (extend DIPs of 3 fingers,
Flexion (80) and extension (70) flex free finger)
Pronation (90) and supination (90) Flexor digitorum profundus (PIPs should be extended
Radial deviation (20) and ulnar deviation (30) while DIPs are flexed)
Fingers Extensor pollicis longus
Flex each finger (triggering) Extensor digitorum
Tip to palm distance, and finger tuck into palm
Thumb opposition (bring thumb parallel to palm)
Functional Grips
Power grips (cylinder, sphere, hook) Special Tests
Precision grips (pinch, 3 jaw chuck, lateral key grip) Phalens test (hold wrists flexed together for 1 min)
Tinels test (tap median nerve in carpal tunnel)
Neurological Upper Extremity Finkelsteins test (make fist with thumb abducted and
Sensory (two-point discrimination may be required) ulnar drift look for DeQuervains tenosynovitis)
Strength Thumb MP joint stability* (stabilize 1st metacarpal,
Reflexes (biceps, triceps, brachioradialis) apply knee-like stress with thumb +/- flexed = ulnar
collateral ligament tear +/- volar plate tear)
Vascular Assessment Rotational deformities (with fingers flexed, look for
Radial pulse crossing of fingers indicating rotational deformities)
Ulnar pulse
Allens test (occlude both arteries, let go of one) * Looking for skiers thumb

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