Examination of a finger was asked in KPF2020.2
Examining a hand in a clinical setting is an important skill, particularly in general practice, where a range of conditions might present. Here is a structured approach to hand examination, which can be remembered with the acronym “LOOK, FEEL, MOVE”:
- Look (Inspection)
- General Observation: Note the patient’s posture and how they use their hands. Observe for any signs of discomfort or guarding.
- Skin: Look for scars, rashes, wounds, swelling, or nail changes. Note any muscle wasting (especially the thenar and hypothenar eminences), deformities (like swan-neck, boutonniere deformities), or nodules (such as Heberden’s and Bouchard’s nodes in osteoarthritis).
- Color: Check for pallor, cyanosis, or erythema.
- Alignment: Observe the fingers’ alignment, noting any deviations or unusual positioning.
- Feel (Palpation)
- Temperature: Use the back of your hand to assess for warmth or cold, which might indicate infection or vascular issues.
- Tenderness: Gently palpate each joint and the soft tissues. This can help localize pain or inflammation.
- Pulses: Palpate the radial pulse.
- Sensation: Test for sensation in each finger, noting any areas of numbness or tingling, which could indicate nerve involvement.
- Move (Movement)
- Active Movement: Ask the patient to flex, extend, abduct, and adduct their fingers. Look for smoothness of movement and any limitations or discomfort.
- Ulnar: adduct/abduct fingers
- Median: opposition of thumb to little finger
- Radial: thumbs up and finger extension
- Passive Movement: Gently move the patient’s fingers through their range of motion to assess for pain, resistance, or crepitus.
- Grip Strength: Assess grip strength by having the patient squeeze your fingers. Compare both hands.
- Fine Motor Skills: Evaluate fine motor skills by asking the patient to perform tasks like picking up small objects or buttoning a shirt.
- Active Movement: Ask the patient to flex, extend, abduct, and adduct their fingers. Look for smoothness of movement and any limitations or discomfort.
- Special Tests
- Phalen’s Test: Ask the patient to press the backs of their hands together for 60 seconds to test for carpal tunnel syndrome.
- Tinel’s Sign: Tap over the carpal tunnel at the wrist to elicit any tingling in the distribution of the median nerve.
- Froment’s Sign: Ask the patient to hold a piece of paper between the thumb and the side of the index finger (pinch grip). If the thumb flexes at the interphalangeal joint (due to weakness of the adductor pollicis), it indicates ulnar nerve dysfunction.
- Finkelstein’s Test: Used to diagnose De Quervain’s tenosynovitis.
- Patient makes fist with fingers overlying thumb
- Examiner gently ulnarly deviates the wrist;positive findings
- Pain along the 1st compartment
- Function and Dexterity
- Assess overall hand function, including grip and pinch strength.
- Observe the patient performing daily activities if possible, to understand how their symptoms affect their daily life.
Remember to compare findings with the other hand and to interpret these findings in the context of the patient’s overall health and specific complaints. It’s crucial to approach this examination in a methodical manner to ensure no significant findings are missed.
In the context of trauma – circulation, sensation and motor function are key things at risk.