Common hand disorders include a variety of deformities, ganglia, infections, Kienböck's disease, nerve compression syndromes, noninfectious tenosynovitis, and osteoarthritis. Complex regional pain syndrome (reflex sympathetic dystrophy) is discussed in Pain: Complex Regional Pain Syndrome, and hand injuries are discussed in Fractures, Dislocations, and Sprains.
History and physical examination findings are often diagnostic in hand disorders.
The history should include information about the trauma or other events that may be associated with symptoms. The presence and duration of deformity and difficulty with motion are noted. The presence, duration, severity, and factors that exacerbate or relieve pain are elicited. Associated symptoms, such as fever, swelling, rashes, Raynaud's syndrome (see Peripheral Arterial Disorders: Raynaud's Syndrome), paresthesias, and weakness, are also recorded.
Examination should include inspection for redness, swelling, or deformity and palpation for tenderness. Active range of motion should be tested for any possible tendon injury. Passive range of motion can assess whether specific motions aggravate pain. Sensation is tested most accurately by 2-point discrimination, using 2 ends of a paper clip. Motor function testing involves muscles innervated by the radial, median, and ulnar nerves. Vascular examination should include evaluation of capillary refill, radial and ulnar pulses, and Allen's test (see Tests of Pulmonary Function (PFT): Arterial Blood Gas Sampling). Stress testing is helpful when specific ligament injuries are suspected (eg, ulnar collateral ligament in gamekeeper's thumb—see Fractures, Dislocations, and Sprains: Ulnar collateral ligament sprains (gamekeeper's thumb)). Provocative testing can aid in the diagnosis of tenosynovitis and nerve compression syndromes.
Laboratory testing has a limited role. Plain x-rays and MRI are helpful for injuries, arthritis, and Kienböck's disease or to rule out hidden foreign bodies that could be sources of infections. Nerve conduction testing can help diagnose nerve compression syndromes. Bone scans may assist in diagnosing occult fractures and reflex sympathetic dystrophy.
Last full review/revision March 2008 by David R. Steinberg, MD