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HandExamination DR AMY ROSS (FY2)OSCE EXAMINATION– what is expected INSPECTION – DORSUM/PALMAR SURFACE/EXTENSOR SURFACE OF ARM PALPATION MOVEMENTS SPECIAL TESTS FUNCTIONAL TESTSBe aware of surroundings – if pillow available place patient’s hands on pillow – fully exposed bare below elbow Be confident, a lot of steps but have a fluent system and practice with signs etc OSCE: hints Know your anatomy for describing deformities and tips handed, do they smoke?ey work as, are they right or leftOSCE CHECK LIST - https://geekymedics.com/wp-content/uploads/2020/09/OSCE-Checklist- Hand-Wrist-Examination.pdfIntroduction 1. Wash hands 2. Introduce yourself to the patient 3. Confirm the patient’s name and date of birth. 4. Briefly explainwhat the examination will involve 5. Gain consent 6. Position the patient, usually seated and with hands on pillow Important - ** ask patient if they are in any pain prior to examiningINSPECTION GENERAL INSPECTION – any hand splints etc DORSUM PALMAR SURFACE EXTENSOR SURFACE OF ARM WHAT SIGNS ARE YOU LOOKING FOR…??DORSUMPALMARSURFACEEXTENSORSURFACE PALPATION PALMAR SURFACE Temperature Assess and compare the temperatureof joints à increased temperatureof a joint & associated with swellingand tendernessà septic arthritis or inflammatoryarthritis. Radial and ulnar pulse Thenar and hypothenar eminence bulk Disuse or lower motor neuron lesions (e.g. ulnar and median nerve). Palmarthickening Thickening of palmar fascia- dupuytren’s Sensation PALPATION DORSAL SURFACE 1 dorsal webspace – radial nerve sensation MCP joint squeeze Tendernesàs suggestive of active inflammatory arthropathy. Bimanual joint palpation Assess for tenderness, irregularitiesand warmth: Metacarpophalangeal joint (MCPJ) Proximal interphalangeal joint (PIPJ) Distal interphalangeal joint (DIPJ) Carpometacarpal joint (CMCJ) of the thumb (squaring is associated with OA) Anatomical snuffbox tenderness suggestiveof scaphoid fracture. ACTIVE MOVEMENT VS PASSIVE MOVEMENT MOVEMENTS MOTOR MOVEMENTSACTIVE VS PASSIVE MOVEMENTS WRIST – flexion, extension, ulnar/radial deviation, pronation and supination FINGER – flexion, extensionWristextensionagainst resistance Nerve assessed: radial nerve Muscles assessed: extensors of the wrist andfingers Index finger ABduction against resistance Nerve assessed: ulnar nerve Muscles assessed: first dorsal interosseous (FDI) Thumb ABduction against resistance Nerve assessed: median nerve Muscle assessed: abductor pollicis brevisSPECIALTESTSFUNCTIONAL TESTS PINCER GRIP POWER GRIP PICK UP SMALL OBJECTRHEUMA TOID ARTHRITIS Chronic autoimmune disorder resulting in symmetrical deforming polyarthropathy DIP joints spared Management – NSAIDS, Steroids, DMARD’s •Swan neck deformity: DIPJ flexion with PIPJ hyperextension. •Z-thumb: hyperextension of the interphalangeal joint, in addition to fixed flexion and subluxation of the metacarpophalangeal joint (MCP). •Z-thumb •Boutonnières deformity: PIPJ flexion with DIPJ hyperextension •MCP Subluxation OSTEOARTHRITIS Bouchard’s nodes: occur at proximal interphalangeal joints. Heberden’s nodes: occur at distal interphalangeal joints. Mechanical joint degradation – degeneration of articular cartilage Management: analgesia, steroid injection, physiotherapy/splints, surgeryCARPEL TUNNEL SYNDROME Median nerve entrapment à compression of median nerve in carpal tunnel Symptoms:pain/burning numbness of thumb + first +middle and radial half ring finger Paraesthesia, Worse at night Signs: loss of power and wasting of thenar eminence Management – splints, corticosteroid injection, carpel tunnel decompressionTRIGGER FINGER Thickening of flexor tendon sheath causing entrapment of pulley near MCP joint Dicomfort/bump at base of digit/catching/clicking sensation Management: splints, NSAIDS, corticosteroid injection, surgical releaseFurther investigations Bloods – FBC, U&E, CRP Nerve Conduction Studies Neurovascular examination upper limbs Further imaging if indicatedThank you! Please complete feedback.. https://app.medall.org/training/feedback/anonymous?organisation=osceprep-3rd- year&keyword=3294a370503d8d3756deb811References https://geekymedics.com/hand-examination/