Physical Examination of Hand

1. Shamima Akter
B. Sc (Honors) in Occupational Therapy
& M. Sc in Rehabilitation Science
Assistant Professor,
Department of Occupational Therapy
Bangladesh Health Professions Institute (BHPI)
Centre for the Rehabilitation of the Paralysed (CRP)
Chapain, Savar

2. HAND ANATOMY

3. BONY PALPATION OF HAND
Metacarpals
The metacarpals may be palpable in order,
moving from the index to the little finger. Keep
thumb on the patient’s palm and locate the base
of the 2nd metacarpal with index and middle
finger, and palpate its full length.
First metacarpal
Palpate from the anatomical snuffbox to the
metacarpophalangeal joint.

4. Continue…
Metacarpophalangeal joint
Move distally from the metacarpals and
palpate the fusiform joints while they are
flexed so that the articulations are exposed.
Phalanges
There are fourteen phalanges on each hand,
since the thumb has two and the other
fingers three each. The proximal and middle
phalanges articulate at the proximal
interphalangeal joints.

6. SOFT TISSUE PALAPATION OF
HAND
 Hand: Zone I- Thenar Eminance
 Hand : Zone II- Hypothenar eminence
 Hand: Zone III- Palm
 Hand : Zone IV- Dorsum
 Hand: Zone V- Phalanges
 Hand: Zone VI- Tufts of fingers

7. Terminology
 Pollicis- Pollex (Thumb)
 Digitiminimi- Little finger
 Brevis- Short
 Longus- Long
 Carpi- 8 Small bones

8. Hand: Zone I – Thenar Eminance
Location:
At the base of thumb
Composition:
Adductor pollicis
Abductor pollicis brevis
Flexor pollicis brevis
Opponens pollicis
Clinical Significance:
Compression of median nerve within carpal
tunnel can cause the thenar eminence to
atrophy.

10. Hand : Zone II – Hypothenar
eminence
Location:
Proximal to the little finger and extends
longitudinally to the pisiform.
Composition:
Abductor digitiminimi
Opponens digitiminimi
Flexor digitiminimi
Clinical significance:
Ulnar nerve compression can cause atrophy
and hypertrophy of hypothenar eminence.

12. Hand: Zone III – Palm
Location
The structure within palm is not distinctly palpable
because of thick mascular padding and palmar fascia
which obscure them.
Contains
 Palmar aponeurosis: The palmar aponeurosis is a
triangular sheet of fibrous tissue covering all long
muscle tendon of the palm.
Apex: Joint at flexor retinaculum at the wrist.
Ends: At the base of finger
Sides: The sides of triangle blend with the fascia covering the
muscle of little finger and thumb.
Clinical significance: Dupytern’s contracture.

15. Hand: Zone III – Palm
(Continue..)
 Finger flexor tendons
 Location: the finger flexor tendons run
in a common sheath deep to the band of
fascia.
 Palpation: Ask the client to flex and
extend finger.
 Clinical significance: Trigger finger.

17. Hand : Zone IV – Dorsum
 Location: Dorsum
 Contains:
 Extensor tendon
 Palpation: Ask to extend finger while wrist is
slightly extended. When extension is resisted by
pressure upon the dorsum of the fingers, the
tendons stand out.
 Clinical Significance: Rheumatoid Arthritis can
cause ulnar drift of the fingers.

20. Hand: Zone V – phalanges
Location
Palmar and lateral side of phalanges
Palpation
*palpate proximal interphalangeal joints – it feels
smooth because flexor and extensor tendons of
the finger cross them.
*lateral surfaces feel fusiform, since they are
covered by thick joint capsule and collateral
ligaments.

21. Hand: Zone V – phalanges
(Continue…)
Clinical significance
 An abnormal fusiform enlargement can
indicate synovitis secondary to RA
(Bouchard’s nodes)
 Swan neck deformity : PIP – hyperextended
and DIP – flexed
 Boutonniere deformity – DIP extend, PIP-
flexed
 OA-palpable bony nodules (Heberden’s
nodes) found on dorsal and lateral surface
of DIP indicates OA

22. Continue…
Mallet finger – if the distal insertion of
the extensor digitorum communis has
been form away from the DIP, the
client will be unable to extend fully.
The deformity is known a mallet finger
Hangnail infection usually starts at the
side of the nail.

29. Hand: Zone – VI Tufts of fingers most of the
hand’s sensory nerve endings
An infection, originating in the finger tufts may
also travel along the tendon sheaths, producing
the four cardinal sign of Kanavel:
fingers held in flexion
uniform swelling of finger
intense pain upon passive extension of the
finger
sensitivity upon palpation along the course
of tendon sheaths.

31. Han
d
Zone
s
Name Location Contains Clinical
significance
Zone
1
Thenar
eminence
At base of
thumb
•Adductor
pollicis
•Abductor
pollicis brevis
•Flexor pollicis
brevis
•Opponens
pollicis
•Compression of
median nerve within
carpal tunnel can
cause the thenar
eminence to atrophy
Zone
2
Hypothenar
eminence
Proximal to
the little
finger and
extends
longitudinall
y to the
• Abductor
digitiminimi
• Flexor
digitiminimi
• Opponens
digitiminimi
•Comprssion of
ulnar nerve can
cause atrophy and
hypertrophy to
hypothenar
eminence.

32. Hand
Zone
s
Name Locatio
n
Contains Clinical significance
Zone
3
Palm
Palm
of
the
hand
Palmar
aponeurosis
Finger flexor
tendons
•Dupytern’s contracture
•Trigger finger
Zone
4
Dorsum
Dorsum
of
the
hand
Extensor tendons •Rheumatoid Arthitis can
cause ulnar drift of the
fingers
Zone
5
Phalanges
of
finger
Palmar
and
lateral
side
of
fingers
Proximal inter
phalangeal (PIP)
joint
Distal
interphalangeal
(DIP) joint
•Bouchard’s nodes
•Swan neck deformity
•Boutonniere deformity
•Heberden’s nodes
•Mallet finger
•Hangnail infection
ne
fts
f
ers
of
e
er
Sensory nerve •Infection

33. Possible questions
 Write down the name of hand zones with its location.
 Write the name of hand zone six/five/ three/ two/four/one with its content and
palpation procedure.
 Which zone is located in base of thumb/ proximal to little finger/ palm/ dorsum/
phalanges of finger/ tuffts of finger- describe the palpation procedures.
 Describe the soft tissue palpation procedure of thenar and hypothenar with the
corresponding clinical significance.
 Write down the clinical significance of hand zone 5.
 Describe the six hand zones with its names, location, content and clinical
significance.
 Which hand zones are prone to develop rheumatoid arthritis- describe.
 Which hand zones is prone to develop dupytern’s contracture- describe.
 What do you know about dupytern’s contracture- describe with its
corresponding zone.
 What do you understand by rheumatoid arthritis - describe with its
corresponding zone
 Describe the procedures of soft tissue palpation for the following hand zones
with its name-
 Wrist zone 1/ 2/ 3/4/5/6