Examination of Handswhat does it mean & what to do about it.

byDon Hudson, D.O.

Before the Examination

What is the patients age and occupationWhich is the dominate handHas there been a prior hand impairment or

injuryWhen did it startWhat have you (the patient) done that

makes it better or worse

Traumatic InjuryInclude the following:When did the injury occurWhere and under what conditions did it

occurHow did the injury occurWhat was the exact position/posture of the

hand at the time of injuryWhat treatment has been given & what

was the effect

Non-Traumatic InjuriesWhen did the pain, sensory change,

swelling or contracture beginHow is function impaired in your

occupation, hobbies and activities of daily living

Are other joints or tendons involvedWhat activities make the pain better or

worseWhat time of the day or night is it worse

Terminology of Exam and Motions

Nerves of the Hands

Fracture Terminology

Testing

Testing

Testing

Testing

Testing

Testing

Testing

Use Pressure Not Clamps

Carpal Tunnel Injury

Trapping the Median Nerve at the wrist crease may cause paresthesias in the median nerve distribution.

Tinel’s sign- percussion over the Median Nerve.

Phalen’s sign- Volar flexion for one minuet will cause paresthesia of the hand

Carpal Tunnel Syndrome

Why are Exams on Hands so Important

The final out come of injured hands frequently rests in your hands.

The payment for injuries rests in your notes.

The long term complications rests in your hands & your documentation.

Documentation

Your notes make a major difference.Your exam makes a huge difference in

where and how the patient is treated.Describe what you see, describe it in

appropriate terms, and any exam or treatments be sure to document what happened as a result of that treatment or examination

When in doubt !!!!!!

Check your own hands.We have working copies of what we are

seeing, don’t be afraid to look at your working copy to see if you can figure out what it should be doing or not doing as the case may be.

Also never be afraid to consult

The idea that you can say;“ It not working, it looks bad & I do not

know what’s wrong” is OK.Just be sure you have completed an exam

or have a good reason why you have not.Unless not indicated most hand injuries

need to be exposed to get a good examination.

THE END