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Syllabus chapter no : 8
Applied anatomy
Patient history
Observation
Introduction
Most active parts of upper limb
Can lead to large functional difficulties
Acts as a motor and sensory organ
Entire upper limb is a kinetic chain
Hand assessment requires 2 objectives:
Assess lesion or injury as accuratly as possible for proper
treatment
Assess remaining function to know incapacity in ADL
Applied anatomy
Distal radioulnar joint
Joint type: uniaxial pivot
joint
Movements: supination
and pronation
Resting position: 10
degree supination
Applied anatomy
radiocarpal (wrist) joint
Joint type: biaxial ellipsoid
joint
Made up of scaphoid, lunate
and radius bone
Radial angulation provides
buttress effect
Movements: flexion/extension
and ulnar/radial deviation
Resting position: neutral with
slight ulnar deviation
Applied anatomy
Triangular fibrocartilage complex
(TFCC)
Connects ulna with lunate
and triquetrum
Acts as a cushion
Provides stability to wrist
Cascade sign
Assessment of hand
Time and date
Demographic data
Patient history
Red flag findings indicates need for referral to physician
Cancer
Cardiovascular
Gastrointestinal / genitourinary
Miscellaneous
neurological
Patient history
Yellow flag findings indicate more extensive
examination may be required
Patient history
What is the patients age?
Colles fracture
Lunate dislocation
Scaphoid fracture
Finger dislocation
Galeazzi fracture
Patient history
What task is the patient
able or unable to perform?
(to know functional
limitations) Buttoming
Dressing
Tying shoelaces
Patient history
When did the injury or
onset occur, and how long
has the patient been
incapacitated? Burns occur at certain time but incapacity occur after
hypertrophic scarring
Wrist injury in gymnastics
rotational stress with ulnar deviation with raquet hitting
repeated twisting injury
FOOSH injury
Patient history
Which hand is the
patients dominant hand?
Vasospastic condition
Other physical findings
Nail bed trauma, toxic
radiation, acute illness,
prolonged fever,
avitaminosis, chronic
alcoholism
beaus line
Other physical findings
Chronic respiratory
disorders
Clubbing of nails
Other physical findings
Subacute bacterial
endocarditis
Other physical findings
Congenital heart disease
Cyanosis
Nail clubbing
Other physical findings
Parkinsons disease
Other physical findings
Raynauds disease
Scaphoid
Pin prick
Sensory examination
Stereognosis
Resisted isometric
Functional assessment (grip)
Functional wrist and hand
scan (to quickly assess
function)
Wrist flexion and extension
Wrist ulnar and radial
deviation
Standard fist
Hook grasp
Staight fist
Pulp to pulp
Tip to tip
Functional assessment (grip)
Types of grip
Power grip
1. Opening of hand
3. Exerted force
4. release
Functional assessment (grip)
Types of power grip
Functional assessment (grip)
Testing grip strength
Grip dynamometer
Functional assessment (grip)
Types of precision grip
Functional assessment (grip)
Testing pinch strength
Functional assessment (grip)
Testing gross coordination
Jebson-taylor hand function
test to assess gross
coordination, prehension
and manipulative skills
Functional assessment (grip)
Testing fine coordination
Purdue pegboard test to
assess fine coordination