Intro + Vitals + General

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1) Inspection:

• SEADS

• Nail changes (clubbing etc)

• Palmar erythema

• Sublaxation, deviation of the fingers and wrist, swan neck, Bouteniers deformity, Heberden/ Bouchard nodes and Z deformity of thumb

2) Palpation:

• Temperature

• Proximal to distal (wrist to fingers) for tenderness

• Squeeze metacarpophalangeal joints for tenderness

• Bimanual palpation of MCP & interphalangeal joints

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3) ROM: Active, Function and Power

• Active: Make a fist – Pronate wrist – extend little finger – extend all fingers

• Function: Pinch grip – thumb Opposition – Power grip – Froment test (pinch grip a paper while being pulled) – Write/undo a button

• Power: Wrist extension (radial nerve) – Thumb abduction (Median) – Finger abduction (ulnar)

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4) Neuro exam of hand:

• Motor: Thumb abduction (Median nerve), Wrist extension (radial nerve), Finger abduction (Ulnar nerve)

• Sensory: Median, ulnar and radial

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5) Special tests:

• Phalen test: Forced wrist flexion against other hand

• Tinel test: Tap over carpal tunnel

• Finkelstein test: Flex thumb and clench fist over it (pain means DeQuervain tenosynovitis)

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6) Thank the Patient!

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7) To complete my exam, I would like to do:

• Check the pulses of the upper limb (radial / ulnar / brachial)

• UL neuro exam

• One joint above and one joint below examination (elbow)

• The other wrist examination