Examination of Hands what does it mean & what to do about it.

1. Examination of Handswhat does it mean & what to do about it. by Don Hudson, D.O.

2. Before the Examination • What is the patients age and occupation • Which is the dominate hand • Has there been a prior hand impairment or injury • When did it start • What have you (the patient) done that makes it better or worse

3. Traumatic Injury Include the following: • When did the injury occur • Where and under what conditions did it occur • How did the injury occur • What was the exact position/posture of the hand at the time of injury • What treatment has been given & what was the effect

4. Non-Traumatic Injuries • When did the pain, sensory change, swelling or contracture begin • How is function impaired in your occupation, hobbies and activities of daily living • Are other joints or tendons involved • What activities make the pain better or worse • What time of the day or night is it worse

5. Proper Names are Important

6. Bony Anatomy

7. Terminology of Exam and Motions

8. Nerves of the Hands Sensory

9. Fracture Terminology

10. Testing

11. Testing

12. Testing

13. Testing

14. Testing

15. Testing

16. Testing Why Your Exam Maybe Wrong

17. Use Pressure Not Clamps

18. Carpal Tunnel Injury • Trapping the Median Nerve at the wrist crease may cause paresthesias in the median nerve distribution. • Tinel’s sign- percussion over the Median Nerve. • Phalen’s sign- Volar flexion for one minuet will cause paresthesia of the hand

19. Carpal Tunnel Syndrome

20. Why are Exams on Hands so Important • The final out come of injured hands frequently rests in your hands. • The payment for injuries rests in your notes. • The long term complications rests in your hands & your documentation.

21. Documentation • Your notes make a major difference. • Your exam makes a huge difference in where and how the patient is treated. • Describe what you see, describe it in appropriate terms, and any exam or treatments be sure to document what happened as a result of that treatment or examination

22. When in doubt !!!!!! • Check your own hands. • We have working copies of what we are seeing, don’t be afraid to look at your working copy to see if you can figure out what it should be doing or not doing as the case may be.

23. Also never be afraid to consult • The idea that you can say; • “ It not working, it looks bad & I do not know what’s wrong” is OK. • Just be sure you have completed an exam or have a good reason why you have not. • Unless not indicated most hand injuries need to be exposed to get a good examination.

24. THE END