Advertisement

Physical Examination of the Hand

  • Fitnat Dinçer
  • Gülbüz Samut
Chapter

Abstract

Thorough physical examination of the hand is crucial in the assessment of hand functions. In this chapter, physical examination of the hand including general inspection, palpation, range of motion assessment of each joint, neurologic examination, and evaluation of the hand’s vascular supply is reviewed in details. Furthermore, the specific tests for carpal tunnel syndrome, Wartenberg’s syndrome, ulnar nerve compression syndromes, and de Quervain’s tenosynovitis are also described. Once the patient enters the room, the clinical examination begins with inspection followed by the palpation of not only soft tissue and bony structures of hand but also the whole upper extremity. Range of motion measurement of the wrist, fingers, and thumb by using a goniometer is an essential component of hand function evaluation. Besides motor and sensory function assessment which is especially important in traumatic hand injuries, the specific tests for the common hand pathologies such as Tinel’s sign and Phalen’s and Finkelstein’s test should be also performed to make an accurate differential diagnosis.

Keywords

Median nerve Carpal tunnel syndrome Ulnar nerve Radial nerve Proximal phalanx 

References

  1. 1.
    Yalinay Dikmen P, Oge AE, Yazici J. Short segment incremental study in ulnar neuropathy at the wrist: report of three cases and review of the literature. Acta Neurol Belg. 2010;110(1):78–83.PubMedGoogle Scholar
  2. 2.
    Graham B. The value added by electrodiagnostic testing in the diagnosis of carpal tunnel syndrome. J Bone Joint Surg. 2008;90(12):2587–93.CrossRefGoogle Scholar
  3. 3.
    Castro WHM, Jerosch J, Grossman TW. Examination and diagnosis of musculoskeletal disorders. New York: Thieme; 2001.CrossRefGoogle Scholar
  4. 4.
    Finney A, Thwaites C. Rheumatoid arthritis. 1: background, symptoms and ensuring prompt diagnosis and treatment. Nurs Times. 2010;106(9):22–4.PubMedGoogle Scholar
  5. 5.
    Gautschi OP, Land M, Hoederath P, Fournier JY, Hilderbrandt G, Cadosch D. Carpal tunnel syndrome—modern diagnostic and management. Praxis (Bern 1994). 2010;99(3):163–73.CrossRefGoogle Scholar
  6. 6.
    Zhang V, Doherty M, Leeb BF. Eular evidence based diagnosis of hand osteoarthritis report of a task force of the EULAR standing Committee for international clinical studies including therapeutics (ESCISIT). Ann Rheum Dis. 2009;68(1):8–17. Epub 2008 Feb 4.Google Scholar
  7. 7.
    Van Linthoudt D. Clinical presentation imaging and treatment of digital osteoarthritis. Rev Med Suisse. 2010;6(240):564–6568.Google Scholar
  8. 8.
    van de Pol RJ, van Trijffel E, Lucas C. Inter-rater reliability for measurements of passive physiological range of motion of upper extremity joints is better if instruments are used: a systematic review. J Physiother. 2010;56(1):7–17.CrossRefGoogle Scholar
  9. 9.
    Ellis B, Bruton A. A study to compare the reliability of composite finger flexion with goniometry for measurements of range of motion in the hand. Clin Rehab. 2002;16(5):562–70.CrossRefGoogle Scholar
  10. 10.
    Carter TI, Pansy B. Accuracy and reliability of three different techniques for manual goniometry for wrist motion; a cadaveric study. J Hand Surg Am. 2009;34(8):1422–8. Epub 2009 Aug 22.CrossRefGoogle Scholar
  11. 11.
    Hunter JM, Schneider LH, Mackin EJ, Callahan AD. Rehabilitation of the hand. Surgery and therapy. St. Louis: C. V. Mosby Company; 1990.Google Scholar
  12. 12.
    de Kraker M, Selles RW. Palmar abduction measurements: reliability and introduction of normative data in healthy children. J Hand Surg Am. 2009;34(9):1704–8. Epub 2009 Sep 17.Google Scholar
  13. 13.
    Aaron E, Goldber MD. Correlation of manual dexterity with USMLE scores and medical student class rank. J Surg Res. 2008;147(2):212–5.CrossRefGoogle Scholar
  14. 14.
  15. 15.
    Collins S, Visscher P, Ce Vet HC. Reliability of the Semmes Weinstein Monofilaments to measure coetaneous sensibility in the feet of healthy subjects. Disabil Rehabil. 2010;32(24):2019–27. doi: 10.3109/09638281003797406. Epub 2010 May 4.CrossRefGoogle Scholar
  16. 16.
    Lehman JB, Abreu BC. Evaluating the hand: issues in Reliability and validity. Phys Ther. 1989;6(12):1025–33.CrossRefGoogle Scholar
  17. 17.
    Moberg E. Objective methods for determining the functional value of sensibility in the hand. J Bone Joint Surg. 1958;40B:454.CrossRefGoogle Scholar
  18. 18.
    Haward BM, Griffin MJ. Repeatability of grip strength and dexterity tests and effects of age and gender. Int Arch Occup Environ Health. 2002;75(1–2):111–9.PubMedGoogle Scholar
  19. 19.
    Stamm TA, Ploner A, Machold KP, Smolen J. Moberg picking-up test in patients with inflammatory joint diseases: a survey of suitability in comparison with button test and measures of disease activity. Arthritis Rheum. 2003;49(5):626–32.CrossRefGoogle Scholar
  20. 20.
    Feng Y, Schlösser FJ. The Semmes Weinstein monofilament examination as a screening tool for diabetic peripheral neuropathy. Vasc Surg. 2009;50(3):675–82.CrossRefGoogle Scholar
  21. 21.
    Jerosch-Herold C. Assessment of sensibility after nerve injury and repair: a systematic review of evidence for validity, reliability and responsiveness of tests. J Hand Surg Br. 2005;30(3):252–64.CrossRefGoogle Scholar
  22. 22.
    Asif M, Sarkar PK. Three-digit Allen’s test. Ann Thorac Surg. 2007;84:686–7.CrossRefGoogle Scholar
  23. 23.
    Brown JM, Mokhtee D, Evangelista MS, Mackinson SE. Scratch collapse test localizes Osborne’s band as the point of maximal nerve compression in cubital tunnel syndrome. Hand (N Y). 2010;5(2):141–7. doi: 10.1007/s11552-009-9225-4. Epub 2009 Sep 23.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Fitnat Dinçer
    • 1
  • Gülbüz Samut
    • 1
  1. 1.Physical and Rehabilitation Medicine DepartmentHacettepe University Faculty of MedicineAnkaraTurkey

Personalised recommendations