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
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
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
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
identifies examiner's impression of injury & potientally complicating factors based on subjective & objective information
explains examiner's goals as well as how the examiner intends on meeting these goals through initial management, treatment, rehabilitation
