Examination of Hands what does it mean

1
Examination of Handswhat does it mean what to
do about it.

• by
• Don Hudson, D.O.

2
Before the Examination

• What is the patients age and occupation
• Which is the dominate hand
• Has there been a prior hand impairment or injury
• When did it start
• What have you (the patient) done that makes it
  better or worse

3
Traumatic Injury

• Include the following
• When did the injury occur
• Where and under what conditions did it occur
• How did the injury occur
• What was the exact position/posture of the hand
  at the time of injury
• What treatment has been given what was the
  effect

4
Non-Traumatic Injuries

• When did the pain, sensory change, swelling or
  contracture begin
• How is function impaired in your occupation,
  hobbies and activities of daily living
• Are other joints or tendons involved
• What activities make the pain better or worse
• What time of the day or night is it worse

5
Proper Names are Important
6
Bony Anatomy
7
Terminology of Exam and Motions
8
Nerves of the Hands
Sensory
9
Fracture Terminology
10
Testing
11
Testing
12
Testing
13
Testing
14
Testing
15
Testing
16
Testing
Why Your Exam Maybe Wrong
17
Use Pressure Not Clamps
18
Carpal Tunnel Injury

• Trapping the Median Nerve at the wrist crease may
  cause paresthesias in the median nerve
  distribution.
• Tinels sign- percussion over the Median Nerve.
• Phalens sign- Volar flexion for one minuet will
  cause paresthesia of the hand

19
Carpal Tunnel Syndrome
20
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.

21
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

22
When in doubt !!!!!!

• Check your own hands.
• We have working copies of what we are seeing,
  dont 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.

23
Also never be afraid to consult

• The idea that you can say
• It not working, it looks bad I do not know
  whats 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.

24

• THE END