Hand Examination



Neurological hints

Dermatomes C6 = thumb & index finger, C7 = middle finger; C8 = ring & little fingers

Meduan Nerve

  • Superficial branch of median N. - over thenar eminence.
    • Discriminates between a high or low median nerve lesion
Median Nerve Moror LOAF muscles out of plane of palm
  • Anterior Interosseous nerve - loss of precise pinch
    • (unable to make 'OK' sign, instead make a square)
    • due to loss of FPL & FDP to index finger

Ulnar Nerve

Sensory Distribution Ulnar Nerve in Hand
  • Splay fingers - ADM & 1st dorsal interosseous (DAB), PAD
  • Wartenburg's sign - little finger lies abducted (unopposed action of EDM)
  • Froment's test – Thumb flexed

Ulnar Nerve Suppliessmall muscles of the handd (bar LOAF)

  • Ulnar Paradox = less clawing of the fingers than a low lesion
    • FDP is involved in high lesions thus flexing MCPJ & relaxing IPJs
Ulnar Claw

Radial Nerve

  • Posterior Interosseous nerve - Wrist dorsiflexion results in radial deviation (since ECU supplied by PIN, but brachioradialis & ECRL are supplied by the Radial nerve)
  • Superficial Branch of Radial Nerve:
    • Wartenburg's Neuritis (compression at the insertion of Brachioradialis)
    • Dellon's sign = active forceful pronation of the forearm & ulnar deviation of the wrist with the elbow extended by the side
    • Tinel's test at the insertion of Brachioradialis

Tendons

Middle Slip (traumatic Boutonnière deformity)

  • Elson's Test. Put finger over edge of table, with PIPJ flexed to 90°& ask Pt to extend against resistance
  • Weakness of resisted extension of PIPJ & hyperextension of DIPJ occurs if the central slip is ruptured
  • Passive test. Flex wrist & MCPJs. Poor passive resistance to pushing over middle phalanx indicates weak extensor mechanism
Extensor compartments
Compartment Contents Pathologic Conditions
APL & EPB DeQuervain's Disease
ECRL & ECRB Tennis elbow
EPL Rupture at Lister's tubercle
EDC & EIP Extensor Tenosynovitis
EDM Rupture (rheumatoid)
ECU Snapping at ulnar styloid

Content by Dr Íomhar O' Sullivan. Last review Dr ÍOS 25/04/24.