- Follows the IP-PASS examination methodology
- Inspection
- Palpation
- Passive Range of Motion
- Active Range of Motion
- Strength & Neurovascular
- Special Tests
Wrist/Hand
GENERAL EXAM
INTRODUCTION
INSPECTION
- Skin
- Color: erythema, ecchymosis, pallor, black
- Trophic changes (altered hair growth, sweat production)
- Scars
- Swelling
- Muscle tone
- Thenar atrophy: Median Nerve injury
- Interosseus atrophy: Ulnar Nerve Injury
- Deformity
- Asymmetry
- Radial or ulnar deviation
- Rotation
- Amputation
- Athritic nodes
- Boutonniere Deformity
- Swan Neck Deformity
- Angulation: Cascade Sign
PALPATATION
- Joint Effusion
- Clicking
- Snapping
- Crepitus
- Tenderness
- Temperature
- Masses
- Areas of Interest
- Anatomic Snuffbox: Scaphoid Fracture
- Distal Radius
- Distal Ulna
- Distal Radioulnar Joint
- Carpal Bones
- Metacarpal Bones
- Metacarpalphalangeal Joints
- Proximal and Distal Interphalangeal Joints
RANGE OF MOTION
- Finger
- MCP: 0° – 85°
- PIP: 0° – 110°
- DIP: 0° – 65°
- Wrist
- Flexion: 80°-90°
- Extension: 60°-70°
- Radial Deviation: 15°-20°
- Ulnar Deviation: 40°-60°
- Pronation: 90°
- Supination: 90°
STRENGTH
- Gross Motor
- Median Nerve: “A-OK” sign: flexion of thumb and index finger or thumb and pinky against resistance
- Ulnar Nerve: Test fingers against resistance in abduction
- Radial Nerve: Test thumb extension against resistance
- Anterior Interosseus Nerve: “A-OK” sign
- Posterior Interosseus Nerve: Most hand and wrist extensors
- Strength
- Extensors
- Flexors
- Ulnar Deviation
- Radial Deviation
- Supination
- Pronation
NEUROVASCULAR
- Sensation
- Recommend: 2 point discrimination (use paper clip)
- Light touch
- Motor:
- Median Nerve: “A-OK” sign: flexion of thumb and index finger or thumb and pinky against resistance
- Ulnar Nerve: Test fingers against resistance in abduction
- Radial Nerve: Test thumb extension against resistance
- Vascular
- Radial pulse
- Ulnar pulse
- Allen’s Test
SPECIAL TESTS / VIDEOS
- De Quervains Tenosynovitis
- Central Slip Extensor Tendon Injury
- Elson’s Test: WikiSM |
- Gamekeeper’s Thumb
- UCL Stress Test (Thumb): WikiSM |
- TFCC Injury
- TFCC Shear Test
- TFCC Stress Test: WikiSM |
- Wartenbergs Syndrome
- Carpal Tunnel Syndrome
- Scapholunate Instability
- Scaphoid Shift Test: WikiSM |
- Lunotriquetral Instability
- Distal Radial Ulnar Joint Instability
- Piano Key Test: WikiSM |
- Carpometacarpal Arthritis
- Thumb CMC Grind Test: WikiSM |
OTHER
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CITATIONS
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