Clinical Examination of the Hand: An Evidence-Based Approach

Description

This handbook brings together the basic elements of hand and upper limb cases, from examination to clinical diagnosis of various hand and upper limb related diseases. It improvises the examination skills of the reader with proficiency to arrive at a provisional diagnosis for the given hand surgery and related diseases. The chapters are presented with simple language, clinical pictures, tables and embedded videos for readers. Written by contributors across the globe, this book is useful for trainees, graduates, postgraduates, and fellows who intend to brush up on their basics and excel in hand surgery. Key Features • Focuses on examination of hand and upper limb cases. • Serves as an illustrated reference of clinical examination for trainees, graduates, post-graduates and fellows. • Uses high-quality operative videos to demonstrate the clinical examination of various diseases of the hand and upper limb. Cover Title Page Copyright Page Dedication Table of Contents Foreword Preface Acknowledgements Editor Contributors Abbreviations Chapter 1 Introduction Hand Hand Architectonic Hand Surfaces Skeleton of the Wrist and Hand Ossification of Bones Movements of Wrist and Hand Joints Hand Geometry Closing the Hand Opening the Hand The Arches of the Hand Basic Hand Postures Synergy Hand Movements and Functions Properties of the Hand in Reaching and Grasping Movements of the Thumb The Hand is the Masterstroke of Performance Hand Functions Grip and Prehension Types of Grip Phases of Prehension The Grip Consists of Three Stages Types of Grip How One Selects a Grip Essentials in the Mechanism of Grip Quintessential for Grip (Good Sensation in the Prehensile Zone and Free Mobility of Fingers) Applied Anatomy Extrinsic Muscles Long Digital Flexor Tendons Palmaris Longus and Little Finger FDS Intrinsic Muscles Prime Function and Role of Lumbricals Significance of Interossei The Extensor Expansion Hand in Space The Hand and the Central Nervous System Funding: NIL References Chapter 2 Clinical Evaluation: History Taking and Arriving at a Clinical Diagnosis History Taking Chief Complaints (Ascending Chronology Duration) History of Presenting Complaints What is the Duration of Pain? How is it Experienced? Whether Associated with Paraesthesia, Numbness? How to Differentiate between Carpal Tunnel Syndrome and C6 Radiculopathy? Provocative Tests Scratch collapse test An Additional Test for Carpal Tunnel Syndrome and its Significance How to Differentiate between C8 and Ulnar Neuropathy? Cervical Myelopathy Pain and Associated Symptoms Is the Pain Associated with Early Morning Stiffness, in Both Hands, Lasts for 30 Minutes, and Goes Away with Activities? Homework What Are the Aggravating and Alleviating Factors of Pain? How Does it Affect Daily Activities? Nocturnal Pain and Disturbances Location of Pain? Homework for Nerve Examination in Wrist and Hand Conditions with Acute Pain and the Significance Conditions with Chronic Infections Presenting with Acute Pain and theIR Significance Chronic Bacterial Infections and Manifestations Fungal Infections Diagnosis of Fungal Infections Deep Fungal Infections Fungal Osteomyelitis Mycobacterial Infections Tuberculous Osteomyelitis of Adult Hands and Children Hansen’s Disease (Leprosy) Cardinal Signs for Diagnosis of Hansen’s Disease (WHO Recommendations) Hypopigmented Anaesthetic Skin Patch Thickened Nerve Skin Lesions Diagnosis Chronic Pain and its Significance Myths and Misnomers in CRPS Tendinopathy Extensor Tendinopathy Extensor Carpi Ulnaris Instability Flexor Tendinopathy Swelling in Hand and the Upper Limb Volar Wrist Ganglion Nodules and Deformity Dupuytren’s Disease Dorsal Dupuytren’s Nodules (DDN) Differential Diagnosis for Palmar Nodules Clinical Findings Deformities Applied Anatomy Palm Spiral Band Web Spaces Digits Pathology Seen in Dupuytren’s Disease Structures Less Involved in Dupuytren’s Disease Common Cord Patterns in Dupuytren’s Disease How to Differentiate between Swan-Neck Deformity by Mallet Finger and Other Causes Reasons for Swan-Neck Deformities Other Than Mallet Injury Manoeuvre to Appreciate the Swan Neck Deformity Critical Points in Physical Examination History Social Information Travel Information Read. At Leisure The McGill Pain Questionnaire References Chapter 3 Physical Examination of the Hand Inspection Tenderness Examination of the Skin Acute Hand Burns Classification of Burns Trophic Changes and Sweating Scar and Skin Contractures Palpation Examination of the Aponeurotic Lesions Tenosynovitis De Quervain’s Tenosynovitis Differential Diagnosis Posture of the Hand/Attitude of the Upper Limb Muscle Weakness/Wasting Swinging of Scapula Trapezius Strength Examination of Musculotendinous Units Joint Range of Motion Total Active and Passive Motion (TAM) Buck–Gramcko’s Method Deformities Elson Test Vascular examination Circulation Assessment of the Vascularity Tinel’s Sign Method Functional Anatomy of the Hand Dorsum of the Hand Palmar Surface of the Hand Why Skin Incisions in the Hand are Zigzag (Brunner’s) Webspace Pulp Fingernails Palmar Creases Significance of Palmar Creases References Chapter 4 Motor Neurological Examination of the Hand and Upper Limb Introduction The Upper Motor Neuronal Pathway The Lower Motor Neuronal Pathway Procedure Inspection Pronator Drift or Pyramidal Drift Testing Muscle Tone Method of Assessing Tone of Muscles Testing Muscle Power Strength Testing Coordination Testing Reflexes Biceps Reflex (Testing C5,6 Myotome) Triceps Reflex (Testing C7 Myotome) Brachioradialis Reflex (Testing C5,6 Myotome) Finger Jerk (Testing C8 Myotome) Pathological Reflexes Neurological Motor Examination in Children Examination of Tone Primitive Reflexes References Chapter 5 Sensory Examination Simple Sensations Sensory Receptors in the Skin The Technique of Sensory Examination Quick Survey Detailed Survey Superficial (Exteroceptive) Sensation 1. Tactile Sensation (Touch) Light Touch – Deep Pressure 2. Pain Sensation 3. Temperature Sensation Proprioceptive Sensation Joint Position Sense Technique Clinical Significance Vibratory Sense Clinical Significance Cortical Sensory Function Stereognosis (Stereos in Greek Means “Solid”) Graphesthesia Two-Point Discrimination Static (Constant) Two-Point Discrimination Moving Two-Point Discrimination Topognosis (Localization) Tactile Gnosis Moberg Pick-Up Test Appreciation of Weights Ninhydrin Test Wrinkle Test Dermatomes Sensory Examination in Peripheral Nerve Lesions Sympathetic Function Assessment in Peripheral Nerve Lesions Trophic Assessment Skin Sweating Sensory Test in Peripheral Nerve Compression References Chapter 6 Dupuytren’s Contracture: Clinical Examination and Classifications Introduction Etiology Pathophysiology Physical Examination and Classifications of Dupuytren’s Contracture Differential Diagnosis Isolated Fifth Ray Involvement in Dupuytren’s Disease Regarding Difficult Forms Conclusion References Chapter 7 Digital Deformities in Rheumatoid Arthritis: Physical Assessment and Clinical Classifications Introduction Etiologies Assessment and Classification of Deformities Wrist and metacarpophalangeal joints Pathophysiology Middle finger deformity Buttonhole deformity (bouttonnière deformity) Pathophysiology Classification Swan-neck deformity Pathophysiology Classifications Mallet finger deformity Pathophysiology Thumb deformity in RA Pathophysiology Classifications Thumb in “Z” Adductus thumb Deformities and instabilities due to tendon ruptures Rupture of extensor pollicis longus Rupture of the flexor pollicis longus Conclusions References Chapter 8A Peripheral Nerve Examination: Radial Nerve Palsy Introduction Concept of Very High, High and Low Radial Nerve Palsy Clinical Examination Can Often Determine Pathology of Nerve Injury Applied Anatomy and Surface Anatomy History Taking Interpretation Interpretation Interpretation Interpretation Interpretation Examination Prerequisites of the Examination Sequence of Examination Tinel’s sign and its interpretation [36] Interpretation Motor Examination Examination of Muscles Innervated by the Radial Nerve Examination of Donor Tendons Sensory Examination Examination of Other Nerves Examination of Adjacent Area Examination Related to Nerve Transfer Evaluation of Sensory Only Symptoms How to Investigate Applications How to Interpret from a Battery of Tests Differential Diagnosis in Patients of Radial Nerve Injury Conclusion References Chapter 8B Peripheral Nerve Examination: Median Nerve Palsy Median Nerve Anatomy Internervous Communications High Median Nerve Palsy Pronator Syndrome Anterior Interosseous Nerve Syndrome Low Median Nerve Palsy References Chapter 8C Peripheral Nerve Examination: Ulnar Nerve Palsy Introduction Anatomy Observe and Palpate Check Sensation Provocative Manoeuvres Motor Examination Manoeuvres Conclusion References Chapter 9 Wrist Examination: A Focused Approach Introduction Inspection Palpation Movement Power Provocation and Instability Tests/Special Tests Conclusion References Chapter 10 Examination of the Ulnar Side of the Wrist Clinical History Physical Examination Ulnocarpal Stress Test Hook of Hamate Fracture Pisiform–Triquetrum (PT) Arthritis Luno-Triquetral (LT) Ligament Tears DRUJ Arthritis and Instability ECU Subsheath TFCC References Chapter 11A Compression Neuropathies: Carpal Tunnel, Guyon’s Canal, Cubital Tunnel Syndrome Carpal Tunnel Syndrome Surgical Anatomy Contents of Carpal Tunnel Median Nerve Supply Presenting Complaints Clinical Examination Provocation Tests General and Motor Examination Diagnosis Comorbid Conditions Postures Double Crush Syndrome Conclusion Pain Evaluation Score Sheet Cubital Tunnel Syndrome Surgical Anatomy Etiologies Clinical Presentations and Findings Scratch collapse Test for Evaluation of Cubital Tunnel Syndrome EMG and NCV Studies Differential diagnosis (severe motor loss with minimal sensory changes). Guyon’s Canal Syndrome Anatomy of Guyon’s Canal Clinical Presentations Diagnosis References Chapter 11B Compression Neuropathy: Radial Tunnel Syndrome Introduction Anatomy Incidence Sign and Symptoms Clinical Evaluation Differential Diagnosis Electromyography (EMG) and Nerve Conduction Study (NCS) Tests Ultrasound Imaging MRI Imaging Conclusion References Chapter 11C Compression Neuropathy: Thoracic Outlet Syndrome Introduction Anatomy Clinical Examination Positive History Inspection and Palpation Provocative Tests Diagnostic Studies Electrodiagnostic Studies References Chapter 12 Brachial Plexus Examination Introduction Anatomy Organization Intermediate Branches Branches at the Level of Roots Branches at the Level of Trunks Branches at the Level of Cords Terminal Branches Common Patterns of Injury Upper Trunk Injury C6–7 Injury Lower Trunk Injury Pan Plexus Injury General Examination Range of Motion Inspection Sensory Examination Motor Examination Neck Chest and Back Shoulder and Arm Elbow and Forearm Wrist Hand Summary References Chapter 13 Elbow/Forearm Examination Acute Emergency Setting Inspection The Loss of Cascade of the Fingers Abnormal Position of the Digits The Benediction Sign Flexion Contractures of the Digits Scars Surface Anatomy Special Tests Hook Test (Sensitivity 81–100%/Specificity 100%) PFP Test (Sensitivity 95%/Specificity 100%) Supination-Pronation Test (Sensitivity 100%) Biceps Squeeze Test (Sensitivity 100%/ Specificity 67%) BA Flex Test (Sensitivity 100%/Specificity 90%) BCI (Sensitivity 88–92%/Specificity 50–100%) BCR (Sensitivity 96%/Specificity 80%) Total Distal Triceps Rupture Triceps Squeeze Test Posteromedial Impingement Syndrome Arm Bar Test Valgus Overload Test/Posteromedial Impingement Test MCL Insufficiency Moving Valgus Stress Test (Sensitivity 100%/Specificity 75%) Valgus Stress Test (Pain: Sensitivity 65%/Specificity 50%, Laxity: Sensitivity 19%/Specificity 100%) Milking Manoeuvre PLRI Table-Top Relocation Test (Sensitivity 100%) Stand-Up Test/ Chair Push-Up Test (Sensitivity 88%) Push-Up Test (Sensitivity 88%) Lateral Pivot Shift Test (Awake: Sensitivity 38%; Anaesthesia: Sensitivity 100%) Lateral Epicondylitis Cozen’s Test Polk’s Test Lateral Maudsley’s Test / Middle Finger Resistance Test Mill’s Test Grip Strength Test (5–8–10% decrease: Sensitivity 83–80–78%/Specificity 80–85–90%) Medial Epicondylitis Epicondylitis Medialis /Golfer’s Elbow Test Polk’s Test Medial References Chapter 14 Examination of the Shoulder Introduction: The Basis for Examination of the Shoulder Patient Positioning Inspection Palpation Shoulder Joint Range of Motion Provocative Examination Manoeuvres Examination of Shoulder Stability References Chapter 15 Instruments and Implants in Hand Surgery Introduction Basic Hand Surgery Set Bone Instruments Set Skin Grafting Set The External Fixator System Used for Forearm and Hand Tendon Surgery Set Microsurgery Set Wrist Arthroscopy Set Endoscopy Set for Carpal Tunnel Release Headless Compression Screw Set Locking Compression Plate Set for Distal Radius Fracture Mini Screw Osteosynthesis Set Suture Anchors References Chapter 16 Radiology of the Wrist and Hand Introduction Posteroanterior View Ancillary PA Views Radiocarpal Joint View Dorsal Tilt View Dynamic PA Views PA in Ulnar Deviation PA in Radial Deviation Lateral View Ancillary Lateral Views Dynamic Lateral View Lateral Flexion and Extension View Oblique View Ancillary Oblique Views Anteroposterior View Dynamic AP View (Clenched Fist View, Carpal Compression or Power Grip View) Other Special Views Radiology for Suspected Scaphoid Fracture [6] Other Special Views for Scaphoid Radiography of the Hand Posteroanterior View Oblique View True Lateral View Evaluating Carpometacarpal joint dislocation [7] Radiography of the Fingers Posteroanterior View True Lateral View for Fingers Oblique View of a Finger Stress Radiograph of Thumb [6] for Ulnar Collateral Ligament (UCL) Injury (Figure 16.49) References Chapter 17 Congenital Hand Malformations Poland Syndrome (OMT Classification, I. A. 1. ii. a.) Phocomelia (OMT Classification, I. A. 1. iv.) Whole Limb Duplication/Triplication (OMT Classification, I. A. 1. v.) Radial Longitudinal Deficiency (OMT Classification, I. A. 2. i., I. B. 2. i.) Ulnar Longitudinal Deficiency (OMT Classification, I. A. 2. ii., I. B. 2. ii.) Ulnar Dimelia (OMT Classification, I. A. 2. iii., I. B. 2. v.) Radioulnar Synostosis (OMT Classification, I. A. 2. v.) Madelung Deformity (OMT Classification, I. A. 2. vii.) Symbrachydactyly (with Ectodermal Elements) (OMT Classification, I. B. 1. ii.) Transverse Deficiency (without Ectodermal Elements) (OMT Classification, I. B. 1. iii.) Cleft Hand (Split Hand and Foot Malformations) (OMT Classification, I. B. 1. iv.) Radial Polydactyly (OMT Classification, I. B. 2. iii.) Cutaneous (Simple) Syndactyly (OMT Classification, I. B. 4. i. a) Osseous (Complex) Syndactyly (OMT Classification, I. B. 4. ii. a) Clinodactyly (OMT Classification, I. B. 4. ii. b) Deformations Constriction Ring Sequence (OMT Classification, II. A.) Dysplasias Macrodactyly (OMT Classification, III. A. 2. i.) Neurofibromatosis (OMT Classification, III. B. 2. i.) Osteochondromatosis (OMT Classification, III. B. 4. i.) Arthrogryposis Multiplex Congenita (OMT Classification, III. C. i.) Camptodactyly (OMT Classification, III. C. ii. a) Syndromes Acrofacial Dysostosis 1 (Nager Type) (MIM 154400) Apert (MIM 101200) Al-Awadi/Raas-Rothschild/Schinzel Phocomelia (MIM 276820) Baller-Gerold (MIM 218600) Bardet-Biedl Beals (MIM 121050) CLOVES (MIM 612918) Carpenter (MIM 201000) Catel-Manzke (MIM 616145) Cornelia de Lange Crouzon (MIM 123500) Down (MIM 190685) Ectrodactyly-Ectodermal Dysplasia-Clefting (MIM 129900) Fanconi pancytopenia (MIM 227650) Freeman Sheldon (MIM 193700) Fuhrmann (MIM 228930) Goltz (Focal Dermal Hypoplasia) (MIM 305600) Gorlin (Basal Cell Nevus Syndrome) (MIM 109400) Greig Cephalopolysyndactyly (MIM 175700) Hajdu-Cheney (MIM 102500) Hemifacial Microsomia (Goldenhar Syndrome) (MIM 164210) Holt-Oram (MIM 142900) Lacrimoauriculodentodigital (Levy-Hollister) (MIM 149730) Larsen (MIM 150250) Laurin-Sandrow (MIM 135750) Leri-Weill Dyschondrosteosis (MIM 127300) Liebenberg Syndrome (MIM186550) Moebius Sequence (MIM 157900) Multiple Synostoses Nail-Patella (MIM 161200) Noonan Oculodentodigital Dysplasia AD (MIM 164200); AR (MIM 257850) Orofaciodigital Otopalatodigital Spectrum (Filamin A) Pallister-Hall (MIM 146510) Pfeiffer (MIM 101600) Pierre Robin Poland (MIM 173800) Proteus (MIM 176920) Roberts (MIM 268300) SC Phocomelia (MIM 26900) Rothmund-Thomson (MIM 268400) Rubinstein-Taybi Saethre-Chotzen (MIM 101400) Split Hand-Foot Malformation Thrombocytopenia Absent Radius (MIM 274000) Townes-Brock Trichorhinophalangeal Ulnar-Mammary (MIM 181450) VACTERL (vertebral defects, anal atresia, cardiac defects, tracheo-esophageal fistula, renal anomalies and limb abnormalities) Association References Index