James Pegrum (Peggers) MB BS BSc MSc MRCS Diploma (IKAR,IUAA,ISMM)
Overview Hand Anatomy Hand Examination Wrist & Arm X Rays
Hand Anatomy
Hand Anatomy – carpal bones “Some Loves Try Positions That They Can’t Handle”
Hand Anatomy – Carpal Tunnel Draw the carpal tunnel incision on each other
Hand Examination Overview Look Systemically Look Locally Feel Move Special Tests Function
look Systemically
Look Locally Finger Nails Clubbing Pitting Onycholysis Dorsum Guttering Bruising Scars Palmar Dupytrens Thenar wasting Scars Joints Heberdens nodes DIP Bourchard’s nodes PIP Deformity
Look Locally
Look
OA vs RA OARA SkinNMay be thin bruised – steriods Erythema Soft tissuesWasting of musclesMuscle wasating Synovitis around joints Warm & Tender BoneDIPJBilateral diffuse PIPJ DefomitySquaring of the palm Joint subluxation DIPJ Ulnar deviation fingers Radial deviation wrist Z deformity of thumb Swan neck & boutonierre
Look – Nails
Look
Peggers Top Tip A Rheumatoid patient what you need to tell the examiner……… Active or inactive disease? How do you tell? If the patient is rheumatoid factor positive? How do you tell?
Look
Peggers Top Tip When looking for a tendon injury place elbows on table/knee wrists flexed and finger pointing to each other………. Simple ask patient to extend the wrist and watch for the cascade
Look
Feel Tenderness Temperture Swelling Bogginess
Move Finger cascade Precision Grip Fist and note strength Supination / Pronation
Special Tests Carpal Tunnel De Quervain’s Flexor Tendons Neurological
Carpal Tunnel Tinels’ Tap Test Phalens Test
De Quervain’s Tests for tenosynovitis / Tendinopathy
Flexor Tendons FDP FDS
Neurological – Median Nerve Look Thenar muscle wasting Carpal tunnel scar Wrist laceration from self harm Feel Radial 3 ½ fingers Test “O Sign” thumb and Index finger
Neurological – Ulnar Nerve Look Hypothenar muscle wasting Wrist and elbow scars Feel Ulnar 1 ½ fingers Test Abduct and adduct fingers
Neurological – Radial Nerve Look Wrist drop Scars around humerus Feel Dorsal 1 st web space Test Wrist extension – “stop sign” Thumbs up
Functions – Day to day living Hold pen and write Keys Buttons on Shirts Stand from sitting
Summary Systemic Features Face Look Nails, Dorsum, Palmar, Joints Feel Tenderness, Swelling, Temperature, Bogginess Move Finger cascade, Precision, Fist, Supination/Pronation Special Tests Carpal tunnel, De Quervain’s, Flexors, Neurological Functions Pen, Keys, Buttons, Standing
X - Rays
Common Fractures
What you have learnt Hand Anatomy Hand Examination Common X Rays
Thank you This lecture and teaching materials can be found on the following website www. peggers super summaries. com (all 1 word)