Hand Examination, OSCE PDF

Preview

Summary

OSCE summary for hand examination, circa 2021...

Description

Hand Examination

Introduction Introduce yourself & establish Pt -Dr. Relationship (Smiling, eye contact & encourage Pt contribution) Patient Information (Name, age etc) Explain what you will do Permission Privacy Obtain Consent Remember WIPE-O mnemonic: Wash hands - Introduction - Patient data - Ensure privacy / Explain Obtain consent

Vital Signs Check for radial pulse and comment on the rate and rhythm (regular or irregular) and compare both sides Blood pressure and temperature Count respiratory rate while measuring the pulse

PARTS acronym for Joint Assessment

P – Pain/tenderness

Bo A – Asymmetry/alignment Sca R – Range of motion abnormality Sw De T – Tone/texture/temperature of soft tissues de S – Special tests Rash Erythema

Skin and nail changes (pitting, ridding) Muscle wasting: thenar and hypothenar wasting Dupuytren contracture Nodes: Heberden and Bouchard 2- Elbow Psoriatic plaques Rheumatoid nodules Gouty Tophi 3- Feel First ask if there is pain or not Temperature and compare both sides

Palpate Radial pulse Ulnar pulse Thenar and hypothenar bulk Palmar thickening (dupuytren contracture) assess nerve sensation: 1-medial nerve 2-ulnar nerve 3-radial nerve Squeeze MCP joints and observe for signs of discomfort Palpate each joint individually: MQP, PIP, DIP in both hands (look for tenderness and asymmetry) Carpometacarpal joint of the thumb Palpate the wrist joint Palpate anatomical snuffbox (tenderness suggest scaphoid fracture) Palpate the ulnar border of each arm to the elbow

Movement Active Turn the hand and make a fist the ask the patient to extend and flex the fingers abduction and adduction Wrist extension and flexion Thumb: abduction, opposition Passive Wrist extension and flexion (feel for crepitus) Finger extension and flexion against resistance (radial nerve) Finger abduction against resistance (ulnar nerve) Thumb abduction against resistance (medial nerve)

Power grip Pincer grip Observe the Tinel test (ta and tingling) Phalen test (

s

Others State that ideally you will do neurovascular examination of upper limbs, and you will examine the elbow and shoulder joints Thank the patient and wash your hand

NOTE: Atypical presentations are common in the very young, in pregnant females and in the very old,...