Screening of Joints
Neck
- ROM
Shoulder
- behind head / to mouth
- to back pocket
Elbows
- flexion / extension elbows
- pronation / supination with thumb up & elbows by side
Wrist
- flexion / extension
Hand
- make fist with thumb in and out
- spread fingers
Functional Assessment of Hand
Power Grip
Precision Grip
Hook Grip
Lateral Pinch Grip
Tip Pinch
1. Tip to Tip Pinch Grip
- pick up coin
2. Lateral pinch grip
- turn key
3. Precision grip
- write with pen
4. Power Grip
- turn knob
5. Hook Grip
- hold suitcase / fingers
Look at Hands / Place on Pillow
Palms up
Scars
- CTD / flexor tendon synovectomy
Swelling
- flexor sheath synovium
Thenar & Hypothenar eminences
Thumb up
Thenar wasting
Swan neck / Boutonniere deformity
Palms down
Wrist
- synovitis / synovectomy
- wrist fusion
- caput ulna
- radial drift
MCPJ
- ulna drift / replacement / synovitis
- tendon subluxation
Fingers
- Swan neck / Boutonniere deformity
- rheumatoid nodules
Feel
Sensation
- median nerve / CTS
- ulnar nerve
Move
Extensor tendons
- drop fingers
- DDx - locked trigger, tendon subluxation, joint subluxation, PIN palsy
EPL
- ruptures over Listers
- IPJ is extended by intrinsics also
Flexor tendons
- rupture IF & thumb (synovitis)
- rupture FPL alone over trapezial ridge (Mannerfelt)
- triggering
MCPJs
- ? subluxed
Boutonniere deformity
- degree of lag
- passively correctable
- ? arthritic changes
Swan neck deformity
- passively correctable
- intrinsic tightness / Bunnell test
- arthritic changes
Bunnell Test
- test with MCP extended and flexed
- correct ulna deviation
- invalidated by MCPJ dislocation
- with tight interossei will have reduced PIPJ flexion with MCPJ extension