The hand

The hand is the medium of introduction to the outside world.

Clinical assessment:
*Symptoms: pain? can be localized, diffuse or referred from the neck, shoulder or mediastinum.
deformity? can be sudden(tendon rupture) or slow.
swelling? RA causes swelling of PIPJ while OA of DIPJ.
sensory &motor deficit &loss of function.

*Signs: ask which is the dominant hand &examine both sides.
Look at … posture, wasting, deformity, lump, nails & at
Skin for scar, color, dry.

Feel the… skin for temperature &texture, pulse, tenderness & lump: related to subcut. tissue, tendon, joint or bone.

Move … active mvt? finger flexion &opposition.
passive mvt? of each joint.
grip strength & pinch grip.

*Neurological examination &
*Functional tests.






Congenital variations: are 7 groups
1-Failure of formation: either:

Transverse failure: at any level(often at forearm& finger).

Longitudinal failure: either:
Radial? radial club hand;
Ulnar? ulnar club hand; or
Central? cleft hand.

2-Failure of differentiation:
Syndactyly(congenital webbing): is the commonest of all congenital variations of the hand. It may be simple(skin only) or complex(skin &bone). ?? surgical finger separation (plus skin graft).
If >2 fingers to be divided, it is wise to stage the procedure.