Here's a step-by-step guide on how to examine a hand, combining physical assessment techniques:
Hand Examination: A Practical Guide
Examining a hand involves a combination of observation and palpation to identify any abnormalities or areas of concern. Here's how to approach it effectively:
1. Visual Inspection
- General Appearance: Note any obvious deformities, swelling, redness, or skin changes.
- Posture: Observe the natural position of the hand, fingers, and wrist. Are there any unusual angles or fixations?
2. Palpation of Bony Structures
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Styloid Processes: Palpate the radial and ulnar styloid processes for tenderness. This involves gently pressing on the bony prominences at the wrist.
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Bones: Carefully palpate the bones of the hand, feeling for any abnormalities or tenderness.
- Example: Press along the back of the hand to assess the metacarpal bones.
3. Joint Examination
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MCP Joints:
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Squeeze Test: Gently squeeze all four MCP (metacarpophalangeal) joints together. This can often reveal pain, particularly in inflammatory conditions.
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Bimanual Palpation: Palpate each MCP joint, feeling for swelling, tenderness, or crepitus. Use both hands for more stability and precision.
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PIP and DIP Joints: Bimanually palpate all of the PIP (proximal interphalangeal) joints and DIP (distal interphalangeal) joints.
- Palpate each joint individually, feeling for any swelling, tenderness, or bony changes.
4. Functional Assessment
- Range of Motion: Assess the active and passive range of motion of the wrist, fingers, and thumb. Check for any limitations or pain during movement.
- Grip Strength: Evaluate the overall strength and function of the hand by asking the patient to perform grip and pinch exercises.
Key Points to Remember:
- Gentle Approach: Always handle the hand with care to avoid causing unnecessary pain.
- Symmetry: Compare the findings between the two hands, to identify subtle differences.
By following these steps, you can conduct a thorough and effective hand examination.
