material used during final exam preparation hope benefit for all *at own risk

1. HANDS EXAMINATION
Sitting hands above 1 pillow.
Exposure both side of shoulder to hand : ask pt to unbutton the shirt
Gpe: distress, pain, comfortable sitting.
Look both hands from shoulder
- Skin
o Scar
o Hair distribution
o Laceration/wound
o Swelling
o Erythema
o Bruises
o Discharge
o Nails: clubbing, pallor
- Muscle
o Wasting
- Bone
o Bulging of bone: malunion nonunion
Feel : hands only. Ask about pain first
- Rise of temperature
- Tenderness
Move
- Make a fist
- Open fist open the finger
- Namaste
- Reverse namaste
- Ulnar deviation
- Radial deviation
Neurological examination test one side only
- Screening neurology : OK sign
- Sensory volar
o Thenar eminence- mn high l
o Tip of index finger- mn low l
o Tip of little finger- un low l
- Sensory dorsal
o Ulnar side- un high l
o Snuff box- radial n
- Motor: compare both side test power
o Abduct thumb- mn low l
o Flexion of index finger- mn high l
o Abd finger- un
o Little finger flexion- un high l
o Extend finger- rn
o Extend wrist- rn

2. Special test for nerve
Froments sign- ulnar nerve
Special test for carpal tunnel syndrome
- Tinel sign
- Phallens test
- Durkan test
Investigation CTS
- Clinical diagnosed!
- X ray: to ro malunion old fracture
- Nerve conduction studies
Management
- Conservative
o Find out any secondary causes
o Apply carpal tunnel splint at night
o If not severe—> advice conservative up to 3 months.
o Severe—> surgery: carpal tunnel release open.