- Neurological:
- two point discrimination:
- used to test sensory innervation of the digits in adult patients, where as, the ability of skin to wrinkle (when placed in water) is used to test sensation in children;
- normal values:
- thumb: 2.5-5 mm; index: 3-5 mm; other digits: 4-6 mm and base of the palmar aspect of the digits: 5-6 mm
- thenar and hypothenar eminences: 5-9 mm, dorsal aspect of the digits: 6-9 mm, mid-palm region: 11 mm, dorsal aspect of the hand: 7-12 mm
- reference:
- A study of the relative responsiveness of five sensibility tests for assessment of recovery after median nerve injury and repair.
- The two-point discrimination test - time for a re-appraisal?
- tinel's sign:
- may be positive w/ nerve compression;
- may be used to following healing of nerve repair;
- brachial plexus - exam:
- median (AIN, high median lesions, low median lesions);
- radial (PIN):
- ulnar (high ulnar lesions, low ulnar lesions);
- Vascular: (diff dx)
- see: vascular repair technique:
- allen test of wrist: radial artery, superficial palmar arch, ulnar artery);
- allen test of common digital artery
- allen test of individual fingers
- Joint ROM:
- functional ROM for wrist flexion and extension is 65 deg;
finger: mp/f/ext pip/f/ext dip/f/ext
90 0-110 80
thumb: IP/flex/ext mp/f/ext
90 to -20 50-0
wrist: flex ext r/dev. u/dv. pronation supination
75 70 25 45 60 60
- Test for Tendon Contractures:
- extrinsic contractures: note whether the patient can fully flex fingers w/ wrist extended;
- bunnel littler test:
- MP held in mild extension, attempt to flex PIP joint;
- if joint can't flex, either intrinsics are tight or capsule contracture
- Motor and Tendon Exam:
- tendon injuries of the hand
- FDP and FDS tendons to each finger are individually tested for strength and excursion;
- Tenderness:
- ulnar sided wrist pain
- radial and snuff box tenderness
- Misc:
- triquetrolunate instability;
- Exam for SLD
- Compartment Contents Pathologic Conditions
1 APL, EPB DeQuervain's Disease
2 ECRL, ECRB Tennis elbow
3 EPL Rupture at Lister's tubercle
4 EDC, EIP Extensor Tenosynovitis
5 EDM Rupture (rheumatoid)
6 ECU Snapping at ulnar styloid