{"id":1095,"date":"2010-12-04T08:53:06","date_gmt":"2010-12-04T08:53:06","guid":{"rendered":"https:\/\/cloverock.info\/mockosce23\/new\/inspection-6\/"},"modified":"2024-02-12T17:12:54","modified_gmt":"2024-02-12T17:12:54","slug":"inspection-6","status":"publish","type":"post","link":"https:\/\/www.qpercom.com\/sim\/index.php\/the-examination-of-the-upper-extremities\/the-wrist-and-the-hand\/inspection-6\/","title":{"rendered":"Inspection"},"content":{"rendered":"<hr \/>\n<h3><span style=\"color: #003366;\">Procedure<\/span><\/h3>\n<ul>\n<li><span style=\"color: #003366;\">The patient bares both arms up to the elbows, and removes jewellery\/watches.<\/span><\/li>\n<li><span style=\"color: #003366;\">The patient sits at an examination table and lifts <\/span><span style=\"color: #003366;\">the arms with stretched elbows and pronated lower arms (<em>up to 90\u00b0 anteflexion<\/em>). <\/span><\/li>\n<li><span style=\"color: #003366;\">This <span style=\"color: #33cccc;\"><strong>position<\/strong><\/span> of the hands is assessed to determine the presence of a <span style=\"color: #33cccc;\"><strong>peripheral nerve injury<\/strong><\/span>. <\/span><\/li>\n<li><span style=\"color: #003366;\"><span style=\"color: #33cccc;\"><strong>Wrist drop<\/strong><\/span> (<em>radial nerve lesion<\/em>), <span style=\"color: #33cccc;\"><strong>claw hand<\/strong><\/span> (<em>ulnar nerve lesion<\/em>), <span style=\"color: #33cccc;\"><strong>preacher\u2019s hand<\/strong><\/span> (<em>median nerve lesion<\/em>).<\/span><\/li>\n<li><span style=\"color: #003366;\">The patient places the lower arms and palms on the table.<\/span><\/li>\n<li><span style=\"color: #003366;\">Inspection from the <span style=\"text-decoration: underline;\">proximal to the distal<\/span> side is preferred.<\/span><\/li>\n<li><span style=\"color: #003366;\">All bone structures are assessed for <span style=\"color: #33cccc;\"><strong>shape<\/strong><\/span> and <span style=\"color: #33cccc;\"><strong>position<\/strong><\/span> (<em>individual position and position relative to the other bone structures and joints<\/em>), whilst comparing left and right.<\/span><\/li>\n<\/ul>\n<hr \/>\n<p><span style=\"color: #003366;\"><em><strong>Dorsal Side<\/strong><\/em><\/span><\/p>\n<p><span style=\"color: #003366;\">Inspect the shape and the position of the following structures <em><strong>[Figure 102]<\/strong><\/em>.<\/span><\/p>\n<p><span class=\"jce_caption\" style=\"display: inline-block; color: #003366;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-1093\" style=\"margin: auto;\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/UpperExtrem_ue-fig-102.jpg\" alt=\"\" width=\"400\" height=\"294\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/UpperExtrem_ue-fig-102.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/UpperExtrem_ue-fig-102-300x221.jpg 300w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><strong><span style=\"width: 400px; display: block;\">Figure 102<\/span><\/strong><\/span><\/p>\n<hr \/>\n<p><span style=\"color: #003366;\"><em><strong>1.\u00a0 Bones and Joints<\/strong><\/em><\/span><\/p>\n<ul>\n<li><span style=\"color: #003366;\">Distal part of the <span style=\"color: #33cccc;\"><strong>radius<\/strong><\/span> and <span style=\"color: #33cccc;\"><strong>ulna<\/strong><\/span> (<em>fracture<\/em>).<\/span><\/li>\n<li><span style=\"color: #003366;\"><span style=\"color: #33cccc;\"><strong>Wrist<\/strong><\/span> joints (radiocarpal joint; ganglion, rheumatoid arthritis).<\/span><\/li>\n<li><span style=\"color: #003366;\"><span style=\"color: #33cccc;\"><strong>Carpals<\/strong><\/span> (<em>scaphoid bone, lunate bone, capitate bone,<\/em> <em>fractures<\/em>).<\/span><\/li>\n<li><span style=\"color: #003366;\"><span style=\"color: #33cccc;\"><strong>Metacarpals<\/strong><\/span> I through to V (<em>acromegaly<\/em>).<\/span><\/li>\n<li><span style=\"color: #003366;\"><span style=\"color: #33cccc;\"><strong>Metacarpophalangeal<\/strong><\/span> joints = MCP II through to V (<em>rheumatoid arthritis<\/em>).<\/span><\/li>\n<li><span style=\"color: #003366;\"><span style=\"color: #33cccc;\"><strong>Phalanges<\/strong><\/span> (<em>acromegaly, amputations, drumstick fingers<\/em>).<\/span><\/li>\n<li><span style=\"color: #003366;\">Proximal <span style=\"color: #33cccc;\"><strong>interphalangeal<\/strong><\/span> joints = PIP II through to V (<em>rheumatoid arthritis, Bouchard\u2019s nodes with osteoarthritis, dislocation<\/em>).<\/span><\/li>\n<li><span style=\"color: #003366;\">Distal <span style=\"color: #33cccc;\"><strong>interphalangeal<\/strong><\/span> joints \u2013 DIP II through to V (<em>Heberden\u2019s nodes with osteoarthritis<\/em>).<\/span><\/li>\n<li><span style=\"color: #003366;\">Joints of the <span style=\"color: #33cccc;\"><strong>pollex<\/strong><\/span> (<em>thumb<\/em>):<\/span>\n<ul>\n<li><span style=\"color: #003366;\"><span style=\"color: #33cccc;\"><strong>Carpometacarpal<\/strong><\/span> joint = CMC I (<em>osteoarthritis<\/em>).<\/span><\/li>\n<li><span style=\"color: #003366;\"><span style=\"color: #33cccc;\"><strong>Metacarpophalangeal<\/strong><\/span> joint = MCP I (<em>dislocation<\/em>).<\/span><\/li>\n<li><span style=\"color: #003366;\"><span style=\"color: #33cccc;\"><strong>Interphalangeal<\/strong><\/span> joint = IP.<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<hr \/>\n<p><span style=\"color: #003366;\"><em><strong>2.\u00a0 Soft Tissue<\/strong><\/em><\/span><\/p>\n<ul>\n<li><span style=\"color: #003366;\"><span style=\"color: #33cccc;\"><strong>Skin<\/strong><\/span> (<em>sclerodactyly, Sudeck atrophy, Raynaud\u2019s syndrome<\/em>) and <span style=\"color: #33cccc;\"><strong>nails<\/strong><\/span> (<em>cyanosis, hourglass nails<\/em>).<\/span><\/li>\n<li><span style=\"color: #003366;\">Muscle contours of the:<\/span>\n<ul>\n<li><span style=\"color: #003366;\"><span style=\"color: #33cccc;\"><strong>Extensors<\/strong><\/span> of the wrist.<\/span><\/li>\n<li><span style=\"color: #003366;\"><span style=\"color: #33cccc;\"><strong>Interosseous<\/strong><\/span> muscles.<\/span><\/li>\n<\/ul>\n<\/li>\n<li><span style=\"color: #003366;\"><span style=\"color: #33cccc;\"><strong>Tendons<\/strong><\/span> and <span style=\"color: #33cccc;\"><strong>tendon sheaths<\/strong><\/span> (<em>rheumatoid arthritis, De Quervain syndrome<\/em>). Particularly, the <span style=\"color: #33cccc;\"><strong>anatomical snuff box<\/strong><\/span> (<em>bordered by the tendons of the extensor pollicis longus, brevis muscles and the extensor retinaculum<\/em>).<\/span><\/li>\n<\/ul>\n<hr \/>\n<p><span style=\"color: #003366;\"><em><strong>Palmar Side<\/strong><\/em><\/span><\/p>\n<p><span style=\"color: #003366;\">Inspect the shape and position of the following structures <em><strong>[Figure 103]<\/strong><\/em>.<\/span><\/p>\n<p><span class=\"jce_caption\" style=\"display: inline-block; color: #003366;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-1094\" style=\"margin: auto;\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/UpperExtrem_ue-fig-103.jpg\" alt=\"\" width=\"400\" height=\"294\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/UpperExtrem_ue-fig-103.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/UpperExtrem_ue-fig-103-300x221.jpg 300w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><strong><span style=\"width: 400px; display: block;\">Figure 103<\/span><\/strong><\/span><\/p>\n<hr \/>\n<p><span style=\"color: #003366;\"><em><strong>1.\u00a0 Bones and Joints <\/strong><\/em><\/span><\/p>\n<ul>\n<li><span style=\"color: #003366;\"><span style=\"color: #33cccc;\"><strong>Pisiform<\/strong><\/span> bone (<em>contour<\/em>).<\/span><\/li>\n<li><span style=\"color: #003366;\"><span style=\"color: #33cccc;\"><strong>Tubercle<\/strong><\/span> of the <span style=\"color: #33cccc;\"><strong>scaphoid<\/strong><\/span> bone (<em>contour<\/em>).<\/span><\/li>\n<li><span style=\"color: #003366;\"><span style=\"color: #33cccc;\"><strong>Wrist<\/strong><\/span> joint (<em>ganglion, rheumatoid arthritis<\/em>).<\/span><\/li>\n<\/ul>\n<hr \/>\n<p><span style=\"color: #003366;\"><strong><em>2.\u00a0 Soft Tissue <\/em><\/strong><\/span><\/p>\n<ul>\n<li><span style=\"color: #003366;\"><span style=\"color: #33cccc;\"><strong>Skin<\/strong><\/span> (<em>callous, sweat secretion, skin creases: Down\u2019s syndrome<\/em>).<\/span><\/li>\n<li><span style=\"color: #003366;\">Muscle contours of the:<\/span>\n<ul>\n<li><span style=\"color: #003366;\"><span style=\"color: #33cccc;\"><strong>Flexors<\/strong><\/span> of the wrist.<\/span><\/li>\n<li><span style=\"color: #003366;\"><span style=\"color: #33cccc;\"><strong>Thenar<\/strong><\/span> eminence (<em>eminence of the thumb<\/em>).<\/span><\/li>\n<li><span style=\"color: #003366;\"><span style=\"color: #33cccc;\"><strong>Hypothenar<\/strong><\/span> eminence (<em>eminence of 5th digit<\/em>).<\/span><\/li>\n<\/ul>\n<\/li>\n<li><span style=\"color: #003366;\"><span style=\"color: #33cccc;\"><strong>Tendons<\/strong><\/span> and <span style=\"color: #33cccc;\"><strong>tendon sheaths<\/strong><\/span> (<em>rheumatoid arthritis<\/em>).<\/span><\/li>\n<li><span style=\"color: #003366;\"><span style=\"color: #33cccc;\"><strong>Palmar fascia<\/strong><\/span> (<em>Dupuytren\u2019s contracture<\/em>).<\/span><\/li>\n<\/ul>\n<hr \/>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Procedure The patient bares both arms up to the elbows, and removes jewellery\/watches. The patient sits at an examination table and lifts the arms with stretched elbows and pronated lower arms (up to 90\u00b0 anteflexion). This position of the hands is assessed to determine the presence of a peripheral nerve injury. Wrist drop (radial nerve [&hellip;]<\/p>\n","protected":false},"author":83,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[64],"tags":[141],"class_list":["post-1095","post","type-post","status-publish","format-standard","hentry","category-the-wrist-and-the-hand","tag-the-examination-of-the-upper-extremities"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Inspection - Qpercom | Skills in Medicine<\/title>\n<meta name=\"description\" content=\"Online Mock OSCEs with examiners, patient actors, instant results and personalised feedback. 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