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Minnesota State University, Mankato
Minnesota State University, Mankato

Wrist/Hand/Fingers Evaluation Module

Page address: http://ahn.mnsu.edu/athletictraining/spata/wristhandfingermodule/

Subjective/History

Determine 6: activity, MOI, location of pain, type of pain, severity of pain, onset of pain, unusual sounds/ sensations, actions that increase & decrease pain, S/S, change in S/S over time, prior injury/ surgery, family history & general medical health

Objective

Inspection 1,6:

General: swelling, discoloration, deformity (ganglion cyst), muscle symmetry/atrophy, gaurding & posture of hand

Skin: discoloration, calluses, open wounds, cuts, scars & skin infections

Fingernails: subungual hematoma, felon, paronychia, color, lunula, spooned, clubbed

Fingers: finger deformities (syndactyly, Heberden's nodes, swan neck, boutonniere, pseudo boutonniere, mallet finger, jersey finger)

Hand: Ape hand, Bishop's deformity, Claw hand, Dupuytern's contracture, Volkman's ischemic contracture

Anterior View: palmar creases(distal palmar crease, proximal palmar crease, proximal interphalangeal crease, thenar crease), thenar eminence & hypothenar eminence

Posterior View:continuity of distal radius, ulna, carpals & metacarpals, alignment of metacarpophanangeal joints

Wrist & Hand Palpation Rollover: using internet explorer rollover the images to trace some anatomy of the elbow

Bony Palpation 1: radial styloid process, anatomic snuffbox, scaphoid, trapezium, first metacarpal, scaphoid tubercle, Lister's tubercle, capitate, lunate, ulnar styloid process, triquetrium, pisiform, hook of the hamate, metacarpals, MP joints, phalanges, IP joint, PIP joints, DIP joints

Soft Tissue Palpation 1:

Wrist Zone 1 (Radial Styloid Process): anatomic snuff box, extensor tunnel I (abductor pollicis longus & extensor pollicis brevis)

Wrist Zone 2 (Listers Tubercle): extensor tunnel II (extensor carpi radialis longus & brevis), extensor tunnel III (extensor pollicis longus), extensor tunnel IV (extensor digitorum communis and extensor indicis)

Wrist Zone 3 (Ulnar Styloid Process): extensor tunnel V (extensor digiti minimi), extensor tunnel VI (extensor carpi ulnaris)

Wrist Zone 4 (Pisiform): flexor carpi ulnaris, Tunnel of Guyon, ulnar artery,

Wrist Zone 5 (Palmaris Longus & Carpal Tunnel): palmaris longus, carpal tunnel, flexor carpi radialis

Hand Zone 1 (Thenar Eminence): abductor pollicis brevis, opponens pollicis, flexor pollicis brevis

Hand Zone 2 (Hypothenar Eminence): abductor digiti minimi, opponens digiti, flexor digiti minimi

Hand Zone 3 (Palm): flexor tendons, interossei, lumbercles

Hand Zone 4 (Dorsum): extensor tendons

Range of Motion 1,5:

AROM:

Forearm: pronation, supination

Wrist: flexion, extension, ulnar deviation, radial deviation

Fingers: flexion, extension, adduction, abduction, opposition, pinch

Thumb: flexion, extension, adduction, abduction

PROM:

Forearm: pronation (90°), supination (90°)

Wrist: flexion (80°), extension (70°), ulnar deviation (30°), radial deviation (20°)

Fingers: MP flexion (90°), MP extension (30-45°), adduction (0°), abduction (20°), opposition, pinch

Thumb: flexion, extension, adduction (0°), abduction (70°)

RROM:

Forearm: pronation, supination

Wrist: flexion, extension, ulnar deviation, radial deviation

Fingers: flexion, extension, adduction, abduction, opposition, pinch

Thumb: flexion, extension, adduction, abduction

Manual Muscle Testing  2:

Palmaris Longus, Extensor Digitorum, Flexor Digitorum Superficialis, Flexor Digitorum Profundus, Flexor Carpi Radialis, Flexor Capri Ulnaris, Extensor Carpi Radialis Longus, Extensor Carpi Radialis Brevis, Extensor Carpi Ilnaris, Pronator Teres, Pronator Quadratus, Supinator, Brachioradialis, Adductor Pollicis, Abductor Pollicis Brevis, Abductor Pollicis Longus, Opponens Pollicis, Flexor Pollicis Longus, Flexor Pollicis Brevis, Extensor Pollicis Longus, Extensor Pollicis Brevis, Abductor Digiti Minimi, Opponens Digiti Minimi, Dorsal Interossei, Palmar Interossei, Lumbricales

Neurovascular Exam

Special Tests  3,7:

Tap/Percussion, MP Torsion/Grind/Compression, Transverse Compression, Finkelstein, Phalen, Reverse Phalen, Tinel's Sign (Radial & Ulnar Nerve), Bunnel Littler, Superficialis, Profundus, Extensor Digitorum, Sweater Finger Sign, Murphy's Sign, Anterior (Palmar) Drawer, Posterior (Dorsal) Drawer, Lunatotriquitrial Ballotment, Valgus (Ulnar) Stress, Varus (Radial) Stress, Digital Allen's, Long Finger Flexion, Lindburgs Sign

Assessment

identifies examiner's impression of injury & potientally complicating factors based on subjective & objective information

Plan

explains examiner's goals as well as how the examiner intends on meeting these goals through initial management, treatment, rehabilitation