Dr. Michael Garcia, Hand and Wrist Examination - Florida Orthopaedic Institute

Pleasure to be back here speaking with you all again. And my topic is going to be a review for a lot of you guys and gals but it may also show in a little bit more specificity some of the special exams that we do for the hand and wrist to review of the pertinent sort of physical exam anatomy and highlight really the importance of using your eyes and your ears to evaluate patients because the majority the hand and wrist examination if you were to go through an entire Hand and wrist examination on every patient that came over the hand complaint you'd be the be in there for 30 minutes. We have so many different tests we can do but by using the history and and using clues and observing the hand you can really pare it down to the very specific area of pain or discomfort and really develop a very quickly a short list of differential diagnosis that you can use to further the treatment of the patient.

So some disclosures I am a consultant for arthritis for Endo Pharmaceuticals and for Axon but I'm not receiving financial compensation for this talk. So we're gonna talk about the hand physical exam like we talked about any physical exam of any other organ system. We're going to break it down into the different sort of aspects of the exam. So as you go through it you can develop an efficient manner in which you can examine the hand and really develop a technique that's unique to your own. So you can be complete and thorough and hit a lot of not only important topics and in organ systems for billing but also to make sure that you don't miss anything that may be a subtle finding on the exam turn to go through observation vascular exam neurologic exam the skeletal RANGE MOTION exam tendons and soft tissues and then ultimately we're going to discuss special test of which there is a myriad of special tests for different sort of pathologic conditions. So first off some general nomenclature, we have our own kind of language when we talk about the hand. And it's a fairly specific we don't talk about medial and lateral when we talk about the hand we talk about radial and owner the thumb side being the radial side the owner side being the small finger side.

When we discuss the sides of the hand the back of the hand is the dorsal surface of the hand or the extensive surface of the hand and the palm or surface of the hand is called the vole or surface of the hand. I don't know what a vole is but I know what a palm is. But nonetheless, we still call it the vole or surf surface the hand. I sure do know what a vole is because I looked it up it's a small little marsupial mammal that's kind of ugly it looks like a miniature possum and we don't call it the digits by numbers. We leave that to the Foot and Ankle Surgeons because other than the big toe the lesser toes don't really matter that much so we can just No them but the fingers are important so we named them. And so it's the thumb the index the long Don't say middle because middle sounds like little.

And that can be very confusing particularly when you're dictating a note as in the transcription is stuck can mess up middle and little so we say long instead of middle and we say ring and then small instead of little because of the. Again the similarity and sounding of the two fingers. And then when we're talking about the joints we talk about the proximal portion of the phalanges excuse me we talk about the proximal phalanges the middle flange in the distal phalanges and then the joints of the proximal interphalangeal joint in the distal interphalangeal joint. And where we abbreviate or shorten those we do not call them pips and dips we call them PIPs and DIPs. very rapidly when you're talking to a hand surgeon and if you call somebody a pip then they begin to become very suspicious of what you're talking about because they know that you may not be very knowledgeable about the hand and specifics and again it's essential to obtain a good history in these patients.

So the physical exam starts with the chief complaint and that can help you pare down the complaints a lot of times people come in and say My hand hurts and what I'll ask him as I say point to where it hurts the most because most people will kind of wave their hand diffuse slowly over the back of the front of their hand showing you where they think that it hurts but if you get them to actually point exactly to where it hurts you can really hone in your physical exam into that area there are conditions that do radiate in the hands and risk but they often begin at a very specific location and if you can learn the surface anatomy and learn to make out in the patient and help you with that by pointing to their location of a discomfort it would be very helpful.

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