Hand exam

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  • Must exam tendon injuries in their entirety through full range of motion
    • Injuries with digits in flexion may cause retraction of cut end of tendon when examined in neutral position
  • All exams should include a thorough history of events



  • General appearance
  • Palpate for: Crepitus, deformity, joint tenderness, rotation deformity, snuffbox tenderness


  • Bilateral grip strength
  • Have patient make a clenched fist
    • Observe orientation and rotation of middle and distal phalanxes
    • Assess for scissoring (overlapping of digits)
    • All phalanges should be oriented parallel to each other with nails in same plane
  • Have patient draw fingertips together so tip of thumb touches tips of the other 4 digits
    • Gross estimation of intact median, ulnar, and radial nerve motor function
  • Pincer function test
    • Weakness suggests median nerve or ulnar collateral ligament disruption


  • Must test with resistance
  • Pain along course of tendon during resistance testing suggests partial rupture
  • Flexor digitorum profundus (FDP)
    • Flex DIP against resistance while MCP and PIP joints are held in extension
  • Flexor digitorum superficialis (FDS) + Flexor pollicis longus (FPL)
    • Flex PIP against resistance while remaining fingers are held in extension
  • Extensor tendons
    • Hand flat an surface and lift fingers individually


  • Assess via cap refill and radial pulse
  • Allen test

Nerve Testing

  • Median
    • Controls thumb opposition and 1st and 2nd lumbricals
    • Have patient touch tip of thumb to tip of little finger with a paper in between. Pull paper away.
    • Sensation to distal 2nd digit
  • Ulnar
    • Controls thumb adduction and 3 and 4th lumbricals
    • Have patient spread the fingers apart against resistance
    • Interpose a tongue deppressor between thumb and index finger and try to pull radially
    • Sensation to distal 5th digit
  • Radial
    • Controls thumb and wrist extension
    • Have patient make "thumbs up" while hand is
    • Sensation over the dorsal web space between the 1st and 2nd digits

See Also