Approach
Start proximally and work distally, to ensure that nothing is missed. It may be helpful to support the patient's hand throughout the examination to ensure patient comfort and maximize examiner control. Bilateral palpation is recommended to compare findings.
Dorsal Aspect
Styloid process of the radius.
Image Source: Victoria Squissato
Styloid process of the ulna.
Image Source: Victoria Squissato
Finger and thumb extensor tendons.
Image Source: Victoria Squissato
Abductor pollicis brevis.
Image Source: Victoria Squissato
Palpate the carpal bones on the dorsal aspect.
Image Source: Victoria Squissato
Metacarpals and phalanges.
Image Source: Victoria Squissato
MCP, PIP, and DIP for synovial thickening, swelling and tenderness.
Image Source: Victoria Squissato
Palmar Aspect
Flexor tendons.
Image Source: Victoria Squissato
Flexor retinaculum.
Image Source: Victoria Squissato
Palmar fascia.
Image Source: Victoria Squissato
Intrinsic muscles of the hand, particularly the thenar and hypothenar muscle masses.
Image Source: Victoria Squissato
Abductor pollicis brevis.
Image Source: Victoria Squissato
Compare the temperature of skin overlying the forearm, wrist joint, and palm using the dorsal surface of your hand.
Image Source: Victoria Squissato
Findings
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Start proximally and work distally, to ensure that nothing is missed. It may be helpful to support the patient's hand throughout the examination to ensure patient comfort and maximize examiner control. Bilateral palpation is recommended to compare findings.
Dorsal Aspect
Styloid process of the radius.
Image Source: Victoria Squissato
Styloid process of the ulna.
Image Source: Victoria Squissato
Finger and thumb extensor tendons.
Image Source: Victoria Squissato
Abductor pollicis brevis.
Image Source: Victoria Squissato
Palpate the carpal bones on the dorsal aspect.
Image Source: Victoria Squissato
Metacarpals and phalanges.
Image Source: Victoria Squissato
MCP, PIP, and DIP for synovial thickening, swelling and tenderness.
Image Source: Victoria Squissato
Palmar Aspect
Flexor tendons.
Image Source: Victoria Squissato
Flexor retinaculum.
Image Source: Victoria Squissato
Palmar fascia.
Image Source: Victoria Squissato
Intrinsic muscles of the hand, particularly the thenar and hypothenar muscle masses.
Image Source: Victoria Squissato
Abductor pollicis brevis.
Image Source: Victoria Squissato
Compare the temperature of skin overlying the forearm, wrist joint, and palm using the dorsal surface of your hand.
Image Source: Victoria Squissato
Findings
- Bony structures: fracture, thickening of the radial or ulnar styloid processes
- Soft-tissue structures: swelling, ganglion, tenosynovitis, thickening of synovial sheaths or flexor retinaculum
- Thenar muscle masses: atrophy, spasm
- Skin temperature: may indicate inflammation, infection, or reduction in circulation
- Crepitus: irregular articular surface, fracture
- Deformity: may indicate rheumatoid arthritis or fracture
- Pulse and circulation: check circulation by blanching the fingernails, colour should return immediately on release of pressure
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