Ortho Exam (Hand and Wrist)

Intro

Candidate introduces self with full name and role

Adheres to appropriate infection control measures

Asks patient if they are in any pain prior to beginning examination

Gains consent and exposes the patient appropriately

Look

Inspects volar aspect of hand / wrist

Inspects doral aspect of hand / wrist

Inspects laterally

Compares hands bilaterally

Comments on 3 of; scars, bruising, muscle wasting, skin changes, contractures, finger cascade, skin colour

Inspects the elbow / forearm briefly for deformity or injury

Feel

Screens for temperature change

Palpates the ulnar and radial pulses

Performs a metacarpal squeeze

Palpates radio-carpal joint

Palpates carpal bones

Palpates metacarpal and phalangeal joints using bimanual technique

Palpates palmar surface for tendon thickening and thenar / hypothenar eminences

Palpates the anatomical snuffbox for tenderness

Screens for nerve injury

Tests radial nerve sensation - dorsal thumb web space

Tests ulnar nerve sensation - pinky sensation

Tests median nerve sensation - finger pulp of the index finger

Move

Active Movovement

Screens for power e.g. finger squeeze (ask the patient to squeeze your fingers)

Tests wrist flexion and extension

Tests wrist ulnar and radial deviation

Tests radial nerve - thumb IP joint extension e.g. thumbs up

Tests ulnar nerve - finger abduction or cross the fingers

Tests median nerve - thumb palmar flexion / making an OK sign

Tests the tendons - screens for normal flexion and extension of the fingers, if any concern performs a full tendon examination of the DIPJ and PIPJs

Tests pincer grip e.g. doing up a button on a shirt

Thumb IP joint extension e.g. thumbs up (radial)

Finger adduction e.g crossing fingers (ulnar)

OK sign (median - AIN branch)

Thumb flexion (median - recurrent branch)

Passive Movements

Passive movement - repeats the above movements passively, whilst isolating the moving joint and checking for RoM and crepitus

Special Tests

Performs Tinels tapping test - if concern over median nerve compression

Performs Phalens test - if concern over median nerve compression

Tests Finkelstein's - if concerned over DeQuervain's tenosynovitis

Tests Froment's - if concerned over ulnar motor nerve palsy

Tests scaphoid compression - if concerned over scaphoid fracture

Complete Examination

Prompts patient to redress

Completes the exam by offering to test distal neurovascular status, examine the joint above (elbow), and to discuss with a senior

Diagnosis and Interpretation

Requests appropriate investigation (Bedside, Bloods, Imaging (including XR with 2 views), Special tests)

Gives appropriate differential

Management

Offers an appropriate management plan (in ortho never forget pain relief, and to fast the patient with IV fluids if they need an operation)

Submit