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Assessment of Hand:

Pinches, Grips, Routine sensory


motor evaluation, Stereognosis

Subject : physical and functional diagnosis

Syllabus chapter no : 8
Applied anatomy
Patient history
Observation
Introduction
Most active parts of upper limb
Can lead to large functional difficulties
Acts as a motor and sensory organ
Entire upper limb is a kinetic chain
Hand assessment requires 2 objectives:
Assess lesion or injury as accuratly as possible for proper
treatment
Assess remaining function to know incapacity in ADL
Applied anatomy
Distal radioulnar joint
Joint type: uniaxial pivot
joint
Movements: supination
and pronation
Resting position: 10
degree supination
Applied anatomy
radiocarpal (wrist) joint
Joint type: biaxial ellipsoid
joint
Made up of scaphoid, lunate
and radius bone
Radial angulation provides
buttress effect
Movements: flexion/extension
and ulnar/radial deviation
Resting position: neutral with
slight ulnar deviation
Applied anatomy
Triangular fibrocartilage complex
(TFCC)
Connects ulna with lunate
and triquetrum
Acts as a cushion
Provides stability to wrist

With TFCC, radius bears


60% load
Without TFCC, radius
bears 95% load
Applied anatomy
intercarpal joints
Proximal row (scaphoid,
lunate, triquetrum)
Distal row (trapezium,
trapezoid, capitate,
hamate)
Applied anatomy
midcarpal joints
Scaphoid, lunate,
triquetrum articulate with
capitate and hamate
Scaphoid articulates with
trapezoid and trapezium
Absence of interosseous
ligaments between
proximal and distal rows
provides greater mobility
at midcarpal joints
Applied anatomy
ligaments of the wrist
Extrinsic ligaments
Radiocarpal
collateral
Ulnocarpal
collateral
TFCC
Dorsal radiocarpal
Applied anatomy
ligaments of the wrist
Intrinsic ligaments
Short
interosseous
Intermediate
Lunotriquetral
Scapholunate
scaphotrapezium
Long
Dorsal intercarpal
Applied anatomy
carpometacarpal joints
1st CMC joint has three
degrees of freedom and
able to adopt any position
2nd and 3rd CMC joints are
relatively immobile and
they are primary
stabilizers of hand
4th and 5th CMC joints are
more mobile and adapt to
different shaped objects
during grasping
Applied anatomy
metacarpophalangeal joints
Joint type: condyloid
Extensor hood reinforces
dorsal aspect of MCP
joints
volar plate reinforces
palmar aspect of MCP
joints
Applied anatomy
interphalangeal joints
Joint type: uniaxial hinge
joint
Resting position: slight
flexion

Cascade sign
Assessment of hand
Time and date

Demographic data
Patient history
Red flag findings indicates need for referral to physician
Cancer
Cardiovascular
Gastrointestinal / genitourinary
Miscellaneous
neurological
Patient history
Yellow flag findings indicate more extensive
examination may be required
Patient history
What is the patients age?

Arthritis common after 40 years of age


Patient history
What is the patients
occupation?

Typists are more suffer from repetitive strain injuries

Automobile mechanics are more suffer from traumatic injuries


Patient history
What was the mechanism
of injury?
Fall on the outstretched hand (FOOSH) injury

Colles fracture
Lunate dislocation
Scaphoid fracture
Finger dislocation
Galeazzi fracture
Patient history
What task is the patient
able or unable to perform?
(to know functional
limitations) Buttoming
Dressing
Tying shoelaces
Patient history
When did the injury or
onset occur, and how long
has the patient been
incapacitated? Burns occur at certain time but incapacity occur after
hypertrophic scarring
Wrist injury in gymnastics
rotational stress with ulnar deviation with raquet hitting
repeated twisting injury
FOOSH injury
Patient history
Which hand is the
patients dominant hand?

Dominant hand is more likely to be injured


Patient history
Has the patient injured
the forearm, wrist or hand
previously?
Was it the same type of
injury?
Was the mechanism of
injury same? If so, how
was it treated?
Patient history
Which part of the forearm,
wrist or hand is injured?
Observation
Observe from proximal to distal and both sides of hand
Observe patients willingness and ability to use hand
Compare both upper limbs for bones and soft tissue
contours
Observe posture of hand at rest for deformities
Observe normal skin creases
Common hand and finger
deformities
swan-neck deformity
Common hand and finger
deformities
Boutonniere deformity
Common hand and finger
deformities
Ulnar drift
Common hand and finger
deformities
Claw fingers
Common hand and finger
deformities
Trigger finger
Common hand and finger
deformities
Ape hand deformity
Common hand and finger
deformities
Bishops hand or benediction hand deformity
Common hand and finger
deformities
Drop-wrist deformity
Common hand and finger
deformities
zigzag deformity of hand
Common hand and finger
deformities
Dupuytrens contracture
Common hand and finger
deformities
Mallet finger
Common hand and finger
deformities
Hand osteoarthritis
Common hand and finger
deformities
Ganglion
Other physical findings
Radiation exposure

Psoriasis brittle nails, longitudinal nail ridges, skin ulceration


Detachment of nails

Hyperthyroidism Nail atrophy

Thin nail fold

Vasospastic condition
Other physical findings
Nail bed trauma, toxic
radiation, acute illness,
prolonged fever,
avitaminosis, chronic
alcoholism
beaus line
Other physical findings
Chronic respiratory
disorders

Clubbing of nails
Other physical findings
Subacute bacterial
endocarditis
Other physical findings
Congenital heart disease

Cyanosis
Nail clubbing
Other physical findings
Parkinsons disease
Other physical findings
Raynauds disease

Intermittent pallor and cyanosis


Other physical findings
Volkmanns ischemic
contracture
radiography
radiography
radiography
radiography
palpation
Palpate forearm, wrist and
hand
palpation
Palpate anatomical snuff
box

Scaphoid

Palpate lunate, pisiform


palpation

Palpate radial and ulnar


arteries
Sensory examination
Sensory examination
Sensory examination
Test moving touch

examiners fingers stroke patients finger


Sensory examination
Test constant light touch
Semmes-weinstein
monofilament examination
(von frey test)
Sensory examination
Pain sensation

Pin prick
Sensory examination
Stereognosis

Normal subject can recognize object within 3 seconds


Sensory examination
Vibration sense

Use 256 cps tuning fork


Sensory examination
Check for referred pain
Motor examination
Active movements

Passive movements with


end feel

Resisted isometric
Functional assessment (grip)
Functional wrist and hand
scan (to quickly assess
function)
Wrist flexion and extension
Wrist ulnar and radial
deviation
Standard fist
Hook grasp
Staight fist
Pulp to pulp
Tip to tip
Functional assessment (grip)
Types of grip

Power grip

Precision or prehension grip


Functional assessment (grip)
Stages of power grip

1. Opening of hand

2. Positioning and closing of fingers and thumb for grasping

3. Exerted force

4. release
Functional assessment (grip)
Types of power grip
Functional assessment (grip)
Testing grip strength
Grip dynamometer
Functional assessment (grip)
Types of precision grip
Functional assessment (grip)
Testing pinch strength
Functional assessment (grip)
Testing gross coordination
Jebson-taylor hand function
test to assess gross
coordination, prehension
and manipulative skills
Functional assessment (grip)
Testing fine coordination
Purdue pegboard test to
assess fine coordination