Clinical Examination of the Hand: An Evidence-Based Approach

Cover
Title Page
Copyright Page
Dedication
Table of Contents
Foreword
Preface
Acknowledgements
Editor
Contributors
Abbreviations
Chapter 1 Introduction
Hand
Hand Architectonic
Hand Surfaces
Skeleton of the Wrist and Hand
Ossification of Bones
Movements of Wrist and Hand Joints
Hand Geometry
Closing the Hand
Opening the Hand
The Arches of the Hand
Basic Hand Postures
Synergy
Hand Movements and Functions
Properties of the Hand in Reaching and Grasping
Movements of the Thumb
The Hand is the Masterstroke of Performance
Hand Functions
Grip and Prehension
Types of Grip
Phases of Prehension
The Grip Consists of Three Stages
Types of Grip
How One Selects a Grip
Essentials in the Mechanism of Grip
Quintessential for Grip (Good Sensation in the Prehensile Zone and Free Mobility of Fingers)
Applied Anatomy
Extrinsic Muscles
Long Digital Flexor Tendons
Palmaris Longus and Little Finger FDS
Intrinsic Muscles
Prime Function and Role of Lumbricals
Significance of Interossei
The Extensor Expansion
Hand in Space
The Hand and the Central Nervous System
Funding: NIL
References
Chapter 2 Clinical Evaluation: History Taking and Arriving at a Clinical Diagnosis
History Taking
Chief Complaints (Ascending Chronology Duration)
History of Presenting Complaints
What is the Duration of Pain?
How is it Experienced?
Whether Associated with Paraesthesia, Numbness?
How to Differentiate between Carpal Tunnel Syndrome and C6 Radiculopathy?
Provocative Tests
Scratch collapse test
An Additional Test for Carpal Tunnel Syndrome and its Significance
How to Differentiate between C8 and Ulnar Neuropathy?
Cervical Myelopathy
Pain and Associated Symptoms
Is the Pain Associated with Early Morning Stiffness, in Both Hands, Lasts for 30 Minutes, and Goes Away with Activities?
Homework
What Are the Aggravating and Alleviating Factors of Pain?
How Does it Affect Daily Activities?
Nocturnal Pain and Disturbances
Location of Pain?
Homework for Nerve Examination in Wrist and Hand
Conditions with Acute Pain and the Significance
Conditions with Chronic Infections Presenting with Acute Pain and theIR Significance
Chronic Bacterial Infections and Manifestations
Fungal Infections
Diagnosis of Fungal Infections
Deep Fungal Infections
Fungal Osteomyelitis
Mycobacterial Infections
Tuberculous Osteomyelitis of Adult Hands and Children
Hansen’s Disease (Leprosy)
Cardinal Signs for Diagnosis of Hansen’s Disease (WHO Recommendations)
Hypopigmented Anaesthetic Skin Patch
Thickened Nerve
Skin Lesions
Diagnosis
Chronic Pain and its Significance
Myths and Misnomers in CRPS
Tendinopathy
Extensor Tendinopathy
Extensor Carpi Ulnaris Instability
Flexor Tendinopathy
Swelling in Hand and the Upper Limb
Volar Wrist Ganglion
Nodules and Deformity
Dupuytren’s Disease
Dorsal Dupuytren’s Nodules (DDN)
Differential Diagnosis for Palmar Nodules
Clinical Findings
Deformities
Applied Anatomy
Palm
Spiral Band
Web Spaces
Digits
Pathology Seen in Dupuytren’s Disease
Structures Less Involved in Dupuytren’s Disease
Common Cord Patterns in Dupuytren’s Disease
How to Differentiate between Swan-Neck Deformity by Mallet Finger and Other Causes
Reasons for Swan-Neck Deformities Other Than Mallet Injury
Manoeuvre to Appreciate the Swan Neck Deformity
Critical Points in Physical Examination
History
Social Information
Travel Information
Read. At Leisure
The McGill Pain Questionnaire
References
Chapter 3 Physical Examination of the Hand
Inspection
Tenderness
Examination of the Skin
Acute Hand Burns
Classification of Burns
Trophic Changes and Sweating
Scar and Skin Contractures
Palpation
Examination of the Aponeurotic Lesions
Tenosynovitis
De Quervain’s Tenosynovitis
Differential Diagnosis
Posture of the Hand/Attitude of the Upper Limb
Muscle Weakness/Wasting
Swinging of Scapula
Trapezius Strength
Examination of Musculotendinous Units
Joint Range of Motion
Total Active and Passive Motion (TAM)
Buck–Gramcko’s Method
Deformities
Elson Test
Vascular examination
Circulation
Assessment of the Vascularity
Tinel’s Sign
Method
Functional Anatomy of the Hand
Dorsum of the Hand
Palmar Surface of the Hand
Why Skin Incisions in the Hand are Zigzag (Brunner’s)
Webspace
Pulp
Fingernails
Palmar Creases
Significance of Palmar Creases
References
Chapter 4 Motor Neurological Examination of the Hand and Upper Limb
Introduction
The Upper Motor Neuronal Pathway
The Lower Motor Neuronal Pathway
Procedure
Inspection
Pronator Drift or Pyramidal Drift
Testing Muscle Tone
Method of Assessing Tone of Muscles
Testing Muscle Power
Strength
Testing Coordination
Testing Reflexes
Biceps Reflex (Testing C5,6 Myotome)
Triceps Reflex (Testing C7 Myotome)
Brachioradialis Reflex (Testing C5,6 Myotome)
Finger Jerk (Testing C8 Myotome)
Pathological Reflexes
Neurological Motor Examination in Children
Examination of Tone
Primitive Reflexes
References
Chapter 5 Sensory Examination
Simple Sensations
Sensory Receptors in the Skin
The Technique of Sensory Examination
Quick Survey
Detailed Survey
Superficial (Exteroceptive) Sensation
1. Tactile Sensation (Touch)
Light Touch – Deep Pressure
2. Pain Sensation
3. Temperature Sensation
Proprioceptive Sensation
Joint Position Sense
Technique
Clinical Significance
Vibratory Sense
Clinical Significance
Cortical Sensory Function
Stereognosis (Stereos in Greek Means “Solid”)
Graphesthesia
Two-Point Discrimination
Static (Constant) Two-Point Discrimination
Moving Two-Point Discrimination
Topognosis (Localization)
Tactile Gnosis
Moberg Pick-Up Test
Appreciation of Weights
Ninhydrin Test
Wrinkle Test
Dermatomes
Sensory Examination in Peripheral Nerve Lesions
Sympathetic Function Assessment in Peripheral Nerve Lesions
Trophic Assessment
Skin Sweating
Sensory Test in Peripheral Nerve Compression
References
Chapter 6 Dupuytren’s Contracture: Clinical Examination and Classifications
Introduction
Etiology
Pathophysiology
Physical Examination and Classifications of Dupuytren’s Contracture
Differential Diagnosis
Isolated Fifth Ray Involvement in Dupuytren’s Disease
Regarding Difficult Forms
Conclusion
References
Chapter 7 Digital Deformities in Rheumatoid Arthritis: Physical Assessment and Clinical Classifications
Introduction
Etiologies
Assessment and Classification of Deformities
Wrist and metacarpophalangeal joints
Pathophysiology
Middle finger deformity
Buttonhole deformity (bouttonnière deformity)
Pathophysiology
Classification
Swan-neck deformity
Pathophysiology
Classifications
Mallet finger deformity
Pathophysiology
Thumb deformity in RA
Pathophysiology
Classifications
Thumb in “Z”
Adductus thumb
Deformities and instabilities due to tendon ruptures
Rupture of extensor pollicis longus
Rupture of the flexor pollicis longus
Conclusions
References
Chapter 8A Peripheral Nerve Examination: Radial Nerve Palsy
Introduction
Concept of Very High, High and Low Radial Nerve Palsy
Clinical Examination Can Often Determine Pathology of Nerve Injury
Applied Anatomy and Surface Anatomy
History Taking
Interpretation
Interpretation
Interpretation
Interpretation
Interpretation
Examination
Prerequisites of the Examination
Sequence of Examination
Tinel’s sign and its interpretation [36]
Interpretation
Motor Examination
Examination of Muscles Innervated by the Radial Nerve
Examination of Donor Tendons
Sensory Examination
Examination of Other Nerves
Examination of Adjacent Area
Examination Related to Nerve Transfer
Evaluation of Sensory Only Symptoms
How to Investigate
Applications
How to Interpret from a Battery of Tests
Differential Diagnosis in Patients of Radial Nerve Injury
Conclusion
References
Chapter 8B Peripheral Nerve Examination: Median Nerve Palsy
Median Nerve Anatomy
Internervous Communications
High Median Nerve Palsy
Pronator Syndrome
Anterior Interosseous Nerve Syndrome
Low Median Nerve Palsy
References
Chapter 8C Peripheral Nerve Examination: Ulnar Nerve Palsy
Introduction
Anatomy
Observe and Palpate
Check Sensation
Provocative Manoeuvres
Motor Examination Manoeuvres
Conclusion
References
Chapter 9 Wrist Examination: A Focused Approach
Introduction
Inspection
Palpation
Movement
Power
Provocation and Instability Tests/Special Tests
Conclusion
References
Chapter 10 Examination of the Ulnar Side of the Wrist
Clinical History
Physical Examination
Ulnocarpal Stress Test
Hook of Hamate Fracture
Pisiform–Triquetrum (PT) Arthritis
Luno-Triquetral (LT) Ligament Tears
DRUJ Arthritis and Instability
ECU Subsheath
TFCC
References
Chapter 11A Compression Neuropathies: Carpal Tunnel, Guyon’s Canal, Cubital Tunnel Syndrome
Carpal Tunnel Syndrome
Surgical Anatomy
Contents of Carpal Tunnel
Median Nerve Supply
Presenting Complaints
Clinical Examination
Provocation Tests
General and Motor Examination
Diagnosis
Comorbid Conditions
Postures
Double Crush Syndrome
Conclusion
Pain Evaluation Score Sheet
Cubital Tunnel Syndrome
Surgical Anatomy
Etiologies
Clinical Presentations and Findings
Scratch collapse Test for Evaluation of Cubital Tunnel Syndrome
EMG and NCV Studies
Differential diagnosis (severe motor loss with minimal sensory changes).
Guyon’s Canal Syndrome
Anatomy of Guyon’s Canal
Clinical Presentations
Diagnosis
References
Chapter 11B Compression Neuropathy: Radial Tunnel Syndrome
Introduction
Anatomy
Incidence
Sign and Symptoms
Clinical Evaluation
Differential Diagnosis
Electromyography (EMG) and Nerve Conduction Study (NCS) Tests
Ultrasound Imaging
MRI Imaging
Conclusion
References
Chapter 11C Compression Neuropathy: Thoracic Outlet Syndrome
Introduction
Anatomy
Clinical Examination
Positive History
Inspection and Palpation
Provocative Tests
Diagnostic Studies
Electrodiagnostic Studies
References
Chapter 12 Brachial Plexus Examination
Introduction
Anatomy
Organization
Intermediate Branches
Branches at the Level of Roots
Branches at the Level of Trunks
Branches at the Level of Cords
Terminal Branches
Common Patterns of Injury
Upper Trunk Injury
C6–7 Injury
Lower Trunk Injury
Pan Plexus Injury
General Examination
Range of Motion
Inspection
Sensory Examination
Motor Examination
Neck
Chest and Back
Shoulder and Arm
Elbow and Forearm
Wrist
Hand
Summary
References
Chapter 13 Elbow/Forearm Examination
Acute Emergency Setting
Inspection
The Loss of Cascade of the Fingers
Abnormal Position of the Digits
The Benediction Sign
Flexion Contractures of the Digits
Scars
Surface Anatomy
Special Tests
Hook Test (Sensitivity 81–100%/Specificity 100%)
PFP Test (Sensitivity 95%/Specificity 100%)
Supination-Pronation Test (Sensitivity 100%)
Biceps Squeeze Test (Sensitivity 100%/ Specificity 67%)
BA Flex Test (Sensitivity 100%/Specificity 90%)
BCI (Sensitivity 88–92%/Specificity 50–100%)
BCR (Sensitivity 96%/Specificity 80%)
Total Distal Triceps Rupture
Triceps Squeeze Test
Posteromedial Impingement Syndrome
Arm Bar Test
Valgus Overload Test/Posteromedial Impingement Test
MCL Insufficiency
Moving Valgus Stress Test (Sensitivity 100%/Specificity 75%)
Valgus Stress Test (Pain: Sensitivity 65%/Specificity 50%, Laxity: Sensitivity 19%/Specificity 100%)
Milking Manoeuvre
PLRI
Table-Top Relocation Test (Sensitivity 100%)
Stand-Up Test/
Chair Push-Up Test (Sensitivity 88%)
Push-Up Test (Sensitivity 88%)
Lateral Pivot Shift Test (Awake: Sensitivity 38%; Anaesthesia: Sensitivity 100%)
Lateral Epicondylitis
Cozen’s Test
Polk’s Test Lateral
Maudsley’s Test /
Middle Finger Resistance Test
Mill’s Test
Grip Strength Test (5–8–10% decrease: Sensitivity 83–80–78%/Specificity 80–85–90%)
Medial Epicondylitis
Epicondylitis Medialis
/Golfer’s Elbow Test
Polk’s Test Medial
References
Chapter 14 Examination of the Shoulder
Introduction: The Basis for Examination of the Shoulder
Patient Positioning
Inspection
Palpation
Shoulder Joint Range of Motion
Provocative Examination Manoeuvres
Examination of Shoulder Stability
References
Chapter 15 Instruments and Implants in Hand Surgery
Introduction
Basic Hand Surgery Set
Bone Instruments Set
Skin Grafting Set
The External Fixator System Used for Forearm and Hand
Tendon Surgery Set
Microsurgery Set
Wrist Arthroscopy Set
Endoscopy Set for Carpal Tunnel Release
Headless Compression Screw Set
Locking Compression Plate Set for Distal Radius Fracture
Mini Screw Osteosynthesis Set
Suture Anchors
References
Chapter 16 Radiology of the Wrist and Hand
Introduction
Posteroanterior View
Ancillary PA Views
Radiocarpal Joint View
Dorsal Tilt View
Dynamic PA Views
PA in Ulnar Deviation
PA in Radial Deviation
Lateral View
Ancillary Lateral Views
Dynamic Lateral View
Lateral Flexion and Extension View
Oblique View
Ancillary Oblique Views
Anteroposterior View
Dynamic AP View (Clenched Fist View, Carpal Compression or Power Grip View)
Other Special Views
Radiology for Suspected Scaphoid Fracture [6]
Other Special Views for Scaphoid
Radiography of the Hand
Posteroanterior View
Oblique View
True Lateral View
Evaluating Carpometacarpal joint dislocation [7]
Radiography of the Fingers
Posteroanterior View
True Lateral View for Fingers
Oblique View of a Finger
Stress Radiograph of Thumb [6] for Ulnar Collateral Ligament (UCL) Injury (Figure 16.49)
References
Chapter 17 Congenital Hand
Malformations
Poland Syndrome (OMT Classification, I. A. 1. ii. a.)
Phocomelia (OMT Classification, I. A. 1. iv.)
Whole Limb Duplication/Triplication (OMT Classification, I. A. 1. v.)
Radial Longitudinal Deficiency (OMT Classification, I. A. 2. i., I. B. 2. i.)
Ulnar Longitudinal Deficiency (OMT Classification, I. A. 2. ii., I. B. 2. ii.)
Ulnar Dimelia (OMT Classification, I. A. 2. iii., I. B. 2. v.)
Radioulnar Synostosis (OMT Classification, I. A. 2. v.)
Madelung Deformity (OMT Classification, I. A. 2. vii.)
Symbrachydactyly (with Ectodermal Elements) (OMT Classification, I. B. 1. ii.)
Transverse Deficiency (without Ectodermal Elements) (OMT Classification, I. B. 1. iii.)
Cleft Hand (Split Hand and Foot Malformations) (OMT Classification, I. B. 1. iv.)
Radial Polydactyly (OMT Classification, I. B. 2. iii.)
Cutaneous (Simple) Syndactyly (OMT Classification, I. B. 4. i. a)
Osseous (Complex) Syndactyly (OMT Classification, I. B. 4. ii. a)
Clinodactyly (OMT Classification, I. B. 4. ii. b)
Deformations
Constriction Ring Sequence (OMT Classification, II. A.)
Dysplasias
Macrodactyly (OMT Classification, III. A. 2. i.)
Neurofibromatosis (OMT Classification, III. B. 2. i.)
Osteochondromatosis (OMT Classification, III. B. 4. i.)
Arthrogryposis Multiplex Congenita (OMT Classification, III. C. i.)
Camptodactyly (OMT Classification, III. C. ii. a)
Syndromes
Acrofacial Dysostosis 1 (Nager Type) (MIM 154400)
Apert (MIM 101200)
Al-Awadi/Raas-Rothschild/Schinzel Phocomelia (MIM 276820)
Baller-Gerold (MIM 218600)
Bardet-Biedl
Beals (MIM 121050)
CLOVES (MIM 612918)
Carpenter (MIM 201000)
Catel-Manzke (MIM 616145)
Cornelia de Lange
Crouzon (MIM 123500)
Down (MIM 190685)
Ectrodactyly-Ectodermal Dysplasia-Clefting (MIM 129900)
Fanconi pancytopenia (MIM 227650)
Freeman Sheldon (MIM 193700)
Fuhrmann (MIM 228930)
Goltz (Focal Dermal Hypoplasia) (MIM 305600)
Gorlin (Basal Cell Nevus Syndrome) (MIM 109400)
Greig Cephalopolysyndactyly (MIM 175700)
Hajdu-Cheney (MIM 102500)
Hemifacial Microsomia (Goldenhar Syndrome) (MIM 164210)
Holt-Oram (MIM 142900)
Lacrimoauriculodentodigital (Levy-Hollister) (MIM 149730)
Larsen (MIM 150250)
Laurin-Sandrow (MIM 135750)
Leri-Weill Dyschondrosteosis (MIM 127300)
Liebenberg Syndrome (MIM186550)
Moebius Sequence (MIM 157900)
Multiple Synostoses
Nail-Patella (MIM 161200)
Noonan
Oculodentodigital Dysplasia AD (MIM 164200); AR (MIM 257850)
Orofaciodigital
Otopalatodigital Spectrum (Filamin A)
Pallister-Hall (MIM 146510)
Pfeiffer (MIM 101600)
Pierre Robin
Poland (MIM 173800)
Proteus (MIM 176920)
Roberts (MIM 268300)
SC Phocomelia (MIM 26900)
Rothmund-Thomson (MIM 268400)
Rubinstein-Taybi
Saethre-Chotzen (MIM 101400)
Split Hand-Foot Malformation
Thrombocytopenia Absent Radius (MIM 274000)
Townes-Brock
Trichorhinophalangeal
Ulnar-Mammary (MIM 181450)
VACTERL (vertebral defects, anal atresia, cardiac defects, tracheo-esophageal fistula, renal anomalies and limb abnormalities) Association
References
Index