Edited by Jonathan Lans and CJ Nessralla - 7/1/2021
Inspection/Palpation
Inspection:
Skin: integrity, discoloration
Swelling/Effusion: location (volar/dorsal, radial/ulnar, specific anatomic space)
Deformity: asymmetry, angulation, rotation, cascade (scissoring of fingers)
Palpation:
Mass: soft/hard, mobile/fixed, fluctuance
TTP
Crepitus
Neurovascular Exam
Innervation of specific muscles
Median nerve
FDS (median): flexion of PIP joint, holding other fingers in extension
FDP (AIN/ulnar): flexion DIP holding PIP in extension
FPL (AIN): IP flexion of the thumb
APB (recurrent branch median): raise thumb off table with dorsum on table
Radial nerve
APL/EPB (PIN): bring thumb out to side
EPL (PIN): thumb hyperextension when flat on the table
EDC (PIN): extension of MCPs
EIP (PIN): extend index finger MCP whilst other finger MCPs flexed
EDM (PIN): extend small finger MCP whilst other finger MCPs flexed
ECRB (radial): extend wrist with hand in a fist
Ulnar nerve
ECU (ulnar): extend and ulnar deviate wrist
Interossei (ulnar): spread fingers
Hypothenar muscles (ulnar): separate small finger from other fingers
Vascular exam
Radial artery: doppler/palpable
Ulnar artery: doppler/palpable
Palmar arch: doppler
Pulse oximetry: >94% = ok, may be lower in patients with COPD
Needle prick with 18G needle
Capillary refill: >2s abnormal
Provocative maneuvers or special tests
Central slip injury: Elson's test DIP should be relaxed (“floppy”) with resisted PIP extension at a 90-degree flexed position, if not there is a concern for central slip injury
UCL tear: radial stress to thumb MCP; >30 degrees of laxity in extension injury to accessory and proper UCL; >30 degrees laxity in flexion injury to proper UCL
Fovea sign: TTP in ulnar fovea, may be indicative of TFCC injury
DRUJ instability: attempt to translate the distal ulna volar and dorsal to the radius