Physical Examination of the Hand

doi:10.1016/j.jhsa.2014.04.026

The Journal of Hand Surgery

Volume 39, Issue 11, November 2014, Pages 2324-2334

https://doi.org/10.1016/j.jhsa.2014.04.026 Get rights and content

Examination of the hand is an essential piece of a hand surgeon's skill set. This current concepts review presents a systematic process of performing a comprehensive physical examination of the hand including vascular, sensory, and motor assessments. Evaluations focused on specific hand diseases and injuries are also discussed. This information can be useful for any health care provider treating patients with hand conditions.

Section snippets

History

The history portion of the hand examination should include general information such as age, sex, hand dominance, occupation, previous hand injury, and preexisting impairment or conditions that may affect function. The history of the present problem differs for acute and chronic conditions.

The history should begin with open-ended questions, letting patients tell their story. After listening to the history, it will be necessary to ask more specific questions to hone in on more pertinent symptoms.

Tendon disorders

Acute tendon injuries are the result of a laceration or avulsion from the bony insertion.

Flexor tendon injuries can be described in 5 zones based on the location of the tendon rupture using surface landmarks of the volar hand (Fig. 7). The digital cascade is observed. A normal digital cascade has each sequential finger slightly more flexed from radial to ulnar (Fig. 8). Any disruption of this cascade suggests a flexor tendon injury. Any skin disruption is a potential site for a tendon

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Imaging
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There are more references available in the full text version of this article.

Cited by (11)

Clinical examination of the hand
2023, Orthopaedics and Trauma
Clinical examination of the hand requires a structured approach allowing the clinician the formulate an appropriate differential diagnosis for the purposes of further investigation and timely diagnosis and management. Eliciting a careful history and subsequently employing the examination principles of inspection, palpation, and movement, followed by targeted special tests, are key to assessing the various pathologies affecting the hand. This article discusses the key elements of history-taking and examination structure when assessing hand pathology, and reviews in detail the special tests involved in common pathology seen in the hand, including osteoarthritis, rheumatoid arthritis, carpal tunnel syndrome, cubital tunnel syndrome, Dupuytren's disease, and de Quervain's tenosynovitis.
Acute Carpal Tunnel Syndrome and Median Nerve Neurapraxia: A Review
2022, Orthopedic Clinics of North America
Citation Excerpt :
Static discrimination and moving/dynamic 2-point discrimination test innervation density as multiple overlapping sensory inputs along with intact cortical integration are required. A normal static 2-point discrimination is less than 6 mm and less than 3 mm when assessed dynamically (Fig. 3).16 Because 2-point discrimination may remain intact with only a few conducting nerve fibers, these are not as sensitive to a gradual decline in nerve function seen during neural compression such as in ACTS.
Traumatic Injuries to the Spinal Cord and Peripheral Nervous System
2021, Emergency Medicine Clinics of North America
Citation Excerpt :
Providers should use motor grading and sensory testing to determine the severity and likely anatomic location(s) of injury (Fig. 3 for sensory distribution of major peripheral nerves). Two-point discrimination is the preferred mode of testing for sensory injury with a recent case series of hand injuries, demonstrating 98.6% sensitivity for detecting nerve injury with a 2-point discrimination tool compared to 82.5% for dry gauze.16,24 Tinel sign also may be present acutely at the area of injury with advancing location and increased pain present in regenerating injuries and developing neuromas, respectively.25
Rehabilitation of collateral ligament and volar plate injuries of the fingers
2020, Kinesitherapie
Les lésions capsuloligamentaires des doigts longs et du pouce sont très fréquentes, notamment en pratique sportive. Leur traitement est souvent considéré comme simple. Cependant, lorsqu’il est différé ou mal effectué, des raideurs articulaires difficiles à corriger apparaissent. La prise en charge doit éviter les immobilisations prolongées ou en position non physiologiques. La mobilisation précoce est recommandée. Pour ne pas compromettre la meilleure récupération fonctionnelle, il faut éviter la perte de l’extension au niveau des IPP et la perte de la flexion au niveau des MP. Au niveau du pouce, il importe de bien évaluer les lésions du ligament collatéral ulnaire. La rééducation doit permettre la récupération de la stabilité articulaire et des amplitudes de mouvement. Il faut prévenir le patient que la récupération des raideurs installées est longue, difficile et contraignante par le port de différentes orthèses. Le risque de séquelles fonctionnelles avec limitation des amplitudes articulaires et de séquelle esthétique avec persistance d’une grosse articulation en particulier au niveau des IPP existe.
Joint injuries of the fingers and the thumb are one of the most common injuries of the hand especially in sport practice. They are often overlooked by patients or even doctors. Thus, improper treatment occurs regularly. Necessary treatment and rehabilitation techniques may be delayed and lead to permanent deformities of the digit. Prolonged immobilization and bad position of the joint can cause stiffness and may subsequently result in irreversible loss of motion in the digit. Timely and accurate diagnosis and appropriate treatment is critical for all joint injuries. Stiffness complications can be more easily prevented than treated. Early motion is recommended. We have to avoid loss of extension for the PIP joint and loss of flexion for the MP joint. At the thumb it is important to properly assess the lesions of the ulnar collateral ligament. Rehabilitation must allow the recovery of joint stability and range of motion. It is necessary to warm the patient that the recovery of the stiffness installed is long, difficult and constraining with wearing of different splints. The risk of functional sequelae with limitation of the range of motion and aesthetic sequelae with persistence of a large joint, in particular at PIP joint, exists.
Kinesiology of the wrist and the hand
2020, Comparative Kinesiology of the Human Body: Normal and Pathological Conditions
This chapter introduces the kinesiology of the wrist joint and the hand both in normal and pathologic conditions. It starts by presenting detailed anatomy and biomechanics of the wrist in the first part of the chapter. The stability philosophy of wrist joint is explained, and the instability patterns are presented. The pathomechanics of wrist injuries are also discussed. In the second part, anatomy and biomechanics of hand are presented in detail, including its flexor and extensor system and the intrinsic mechanism. The pathomechanics of hand injuries are also discussed in a clinical view.
Hand injury without any deficit: Is systematic surgical exploration justified?
2019, Hand Surgery and Rehabilitation
Citation Excerpt :
Undiagnosed damage to a major structure in the hand after an apparently harmless wound or cut can lead to severely impaired hand function or infection, or both [4]. Even though meticulous clinical examination in the ED provides valuable information [5] on the potential damage to functional structures of the hand, some lesions remain undiagnosed, and can be underestimated during this first physical examination (e.g. partial tendon tears, sheath breaches, joint capsule breaches, partial nerve cuts, partial artery wounds with secondary thrombosis). A literature review found the incidence of partial tendon tears after a hand wound reaching 30% [6,7].
Out of 100,000 inhabitants, 700 to 4000 suffer a hand wound each year. Numerous hand wounds that may not have a clinically evaluated deficit, actually have damage to a major structure after surgical exploration in the operating room (OR). The aim of our study was to evaluate the incidence of major structure damage within a population of patients presenting a hand wound with no deficit on the clinical examination. Every patient older than 12 years, consulting for a wound deeper than the dermis with no clinical signs of major structure damage underwent surgical treatment and exploration of the wound under regional anesthesia in the OR. After each surgery, the surgeon filled out an anonymous study form describing the wound characteristics and the potential findings of major structure damage. Of the 145 wounds with normal clinical examination, we found that 58.6% had a major structure damaged. Given that damage to any major structure in the hand can lead to functional sequela, and the fact that a well-conducted clinical examination by a qualified hand surgeon is not sufficient to eliminate major structure damage, we recommend systematic surgical exploration of hand wounds, even when no clinical deficit is evident.
Type of sudy: diagnostic study.
Entre 700 et 4000 personnes sur 100 000 habitants sont victimes chaque année d’une plaie de main. De nombreuses plaies de main, pourtant cliniquement évaluées comme non déficitaires, s’avèrent présenter des lésions d’éléments nobles après exploration chirurgicale. L’objectif de notre étude était d’évaluer l’incidence des lésions de structures nobles sur un panel de plaies de main jugées comme cliniquement rassurantes. Nous avons inclus tous les patients âgés de plus de 12 ans présentant une plaie dont la profondeur dépassait le derme et dont l’examen clinique initial était jugé rassurant. Les patients inclus dans l’étude ont alors bénéficié d’une exploration de leur plaie au bloc opératoire, en chirurgie ambulatoire, sous anesthésie locorégionale. En fin d’intervention, il était demandé à l’opérateur de renseigner au moyen d’un formulaire spécifique et anonyme les caractéristiques de la plaie et s’il existait une lésion d’un élément noble. Sur les 145 plaies explorées qui présentait un examen clinique normal, 58,6 % comportaient une lésion d’un élément noble. Sachant qu’une atteinte non diagnostiquée d’un élément noble à la main peut être responsable de séquelles majeures et qu’un examen clinique normal réalisé par un praticien expérimenté est insuffisant pour affirmer l’absence de lésion d’un élément noble, nous recommandons l’exploration chirurgicale systématique de toutes plaies de main.
Étude : Diagnostique.

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View full text

Current conceptsPhysical Examination of the Hand

Section snippets

History

Tendon disorders

J Hand Surg Am

J Hand Surg Am

The Hand: Anatomy, Examination and Diagnosis

Nerve

Sensibility testing in peripheral-nerve compression syndromes: an experimental study in humans

J Bone Joint Surg Am

Tendon

Flexor tendon injury: acute injuries

Extensor tendon injury

Imaging

Acute vascular injuries of the upper extremity

Current concepts
Physical Examination of the Hand