Hand exam


Wrist and hand deeper palmar dissection
Distal interphalangeal dislocation (DIP), proximal interphalangeal dislocation (PIP), and metacarpophalangeal dislocation (MCP) joints of the finger shown.
Volar/anterior finger anatomy.
Lateral finger anatomy.
  • Must exam tendon injuries in their entirety through full range of motion
    • Injuries with digits in flexion may cause retraction of cut end of tendon when examined in neutral position
  • All exams should include a thorough history of events

Hand Anatomy

  • Volar = anterior = dorsal
  • Dorsal = posterior = palmar

Nailtip Anatomy

A. Nail plate; B. lunula; C. root; D. sinus; E. matrix; F. nail bed; G. hyponychium; H. free margin.
  • The perinychium includes the nail, the nailbed, and the surrounding tissue.
  • The paronychia is the lateral nail folds
  • The hyponychium is the palmar surface skin distal to the nail.
  • The lunula is that white semi-moon shaped proximal portion of the nail.
  • The sterile matrix is deep to the nail, adheres to it and is distal to the lunule.
  • The germinal portion is proximal to the matrix and is responsible for nail growth.



  • General appearance
    • Wounds, atrophy, discoloration, swelling, masses, nail changes
  • Palpate for: Crepitus, deformity, joint tenderness, rotation deformity, snuffbox tenderness


  • Bilateral grip strength
  • Have patient make a clenched fist
    • Observe orientation and rotation of middle and distal phalanxes
    • Assess for scissoring (overlapping of digits)
    • All phalanges should be oriented parallel to each other with nails in same plane
  • Have patient draw fingertips together so tip of thumb touches tips of the other 4 digits
    • Gross estimation of intact median, ulnar, and radial nerve motor function
  • Pincer function test
    • Weakness suggests median nerve or ulnar collateral ligament disruption


  • Must test with resistance
  • Pain along course of tendon during resistance testing suggests partial rupture
  • Flexor digitorum profundus (FDP)
    • Flex DIP against resistance while MCP and PIP joints are held in extension
  • Flexor digitorum superficialis (FDS)
    • Flex PIP against resistance while remaining fingers are held in extension, especially the DIPs of the remaining fingers
  • Extensor tendons
    • Hand flat on surface and lift fingers individually


  • Assess via cap refill and radial pulse
  • Allen test

Nerve Testing

  • Median
    • Controls thumb opposition and 1st and 2nd lumbricals
    • Recurrent motor branch: Have patient touch tip of thumb to tip of little finger so the nails are touching
    • Anterior interosseous branch: Have patient make an OK-sign. Thumb IP and index DIP should be flexed, making a circle shape rather than a teardrop shape
    • Sensation to distal 2nd digit
  • Ulnar
    • Controls thumb adduction and 3 and 4th lumbricals
    • Have patient spread the fingers apart against resistance
    • Interpose a tongue depressor between thumb and index finger and try to pull radially
    • Sensation to distal 5th digit
  • Radial
    • Controls thumb and wrist extension
    • Have patient make "thumbs up". Alternatively, have patient perform wrist extension against resistance (tests for wrist drop)
    • Sensation over the dorsal web space between the 1st and 2nd digits

See Also