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Evaluation of the Hand

By

Alexandra Villa-Forte

, MD, MPH, Cleveland Clinic

Last full review/revision Feb 2020| Content last modified Feb 2020
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Physical Examination of the Hand

Physical examination of the hand involves

  • Inspection

  • Palpation

  • Range of motion and strength testing

  • Tests for impingement

The overall appearance of the hand is assessed. The hand is observed first in the position of function, or rest position; normally, the fingers are flexed uniformly and are not parallel to each other. Instead, they converge and point to a single point on the wrist. The hand is next observed with the fingers straight and flexed 90° at the metacarpophalangeal (MCP) joints; normally, the fingernails should all be parallel in the same plane when viewed end-on. (See also physical examination of hand disorders Physical examination Common hand disorders include a variety of deformities, ganglia, infections, Kienböck disease, nerve compression syndromes, noninfectious tenosynovitis, and osteoarthritis. (See also complex... read more Physical examination and Pain in Multiple Joints Pain in Multiple Joints Joints may simply be painful (arthralgia) or also inflamed (arthritis). Joint inflammation is usually accompanied by warmth, swelling (due to intra-articular fluid, or effusion), and uncommonly... read more .)

The hand is inspected for gross deformity, redness, and swelling, particularly at the MCP and interphalangeal joints. Lesions of the skin and nails are noted, as is muscular atrophy on the dorsum of the hand between the metacarpals, and on the palm, particularly the thenar eminence and hypothenar eminence.

The hand is gently palpated for increased warmth, then is systematically palpated bimanually for tenderness over each of the bones and joints. Use of only one finger to palpate can help isolate a tender area.

Overall range of motion and strength is tested by having the patient first make a tight fist around the examiner's 1st and 2nd fingers and then fully extending and spreading all the patient's fingers against squeezing resistance by the examiner's thumb and index finger.

Range of motion and strength of each digit is assessed, starting with the thumb individually and its ability to remain opposed to (pinched tightly against) each of the fingertips, as the examiner's index finger tries to pull through the pinch. Each of the fingers is assessed:

Impingement is assessed:

Digital nerve injury can be assessed by testing two-point discrimination at the fingertips. A calipers or a bent paper clip is used. The test is first demonstrated to the patient and then is done with the patient's eyes shut. A wide gap of the calipers that the patient can clearly distinguish is used first. Touching on the side of the fingertip, sometimes with one point only, and sometimes with two points simultaneously, the gap is gradually narrowed until the patient cannot discriminate one point from two. The shortest distance that the patient can discriminate is measured. The examination is repeated on the unaffected side. Discrimination ability normally should be within about 2 mm on each side.

Arthrocentesis of the Metacarpophalangeal and Interphalangeal Joints of the Hand

Metacarpophalangeal joints and interphalangeal joints of the hands are punctured similarly to each other. A 25- to 30-gauge needle is used to place a wheal of local anesthetic over the needle entry site. A 22- to 25-gauge needle is used to aspirate the joint. Distraction (pulling) of the joint is sometimes useful to open the joint space and allow easier access. The interphalangeal joints are flexed 15 to 20°. The skin is entered perpendicularly at the level of the joint line, just medial or lateral to the extensor tendon, and the needle is directed into the joint space, with back pressure on the syringe plunger during the advance. Synovial fluid will enter the syringe when the joint is entered.

Arthrocentesis of the metacarpophalangeal or interphalangeal joint

Synovial fluid is withdrawn from the metacarpophalangeal or interphalangeal joint. The patient's hand is pronated and the interphalangeal joints are flexed 15 to 20°. Distal traction is applied to the finger. Needle entry occurs along the dorsal portion of the joint, just medial or lateral to the extensor tendon.

Arthrocentesis of the metacarpophalangeal or interphalangeal joint
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