Examination to Demonstrate Injuries to the Tendons of the Hand Injuries to the tendons of the hand can significantly impact hand function and require thorough examination to assess the extent of damage and determine appropriate treatment. Here’s a structured approach to conducting a comprehensive examination: 1. History Taking Begin by obtaining a detailed history, focusing on the mechanism of injury, timing of onset, any associated symptoms (such as pain, swelling, or stiffness), and the patient's hand dominance. Relevant medical history, including any previous hand injuries or surgeries, should also be noted. 2. General Inspection Start with a general inspection of both hands, noting any visible deformities, swelling, discoloration, or scars. Compare the injured hand with the unaffected hand for symmetry and any obvious abnormalities. 3. Palpation Systematically palpate the entire hand, including the palm, dorsum, and each finger. Pay particular attention to tendon sheaths and tendon insertion points for tenderness, swelling, or crepitus (grating sensation). Palpate along the course of each tendon to identify focal areas of pain or thickening. 4. Range of Motion Assessment Evaluate active and passive range of motion (ROM) of each joint in the affected hand and compare with the unaffected hand. Assess flexion, extension, abduction, adduction, and rotational movements of the fingers, thumb, wrist, and forearm. Note any limitations in ROM, pain with movement, or mechanical block to movement. 5. Muscle Strength Testing Test the strength of each muscle group that is innervated by the affected tendons. This typically includes testing grip strength, finger flexion and extension strength, thumb opposition strength, and wrist flexion and extension strength. Compare with the strength of the unaffected hand to detect deficits. 6. Special Tests Use specific maneuvers to assess the integrity of individual tendons and their functional capabilities: • • • Finkelstein's Test: Used to assess for de Quervain's tenosynovitis affecting the abductor pollicis longus and extensor pollicis brevis tendons. Froment's Sign: Tests for ulnar nerve palsy by assessing thumb adduction strength when pinching a paper between the thumb and index finger. Jersey Finger Test: Tests the integrity of the flexor digitorum profundus tendon by assessing the ability to flex the distal interphalangeal joint while holding the proximal interphalangeal joint in extension. 7. Diagnostic Imaging Consider imaging studies such as X-rays, ultrasound, or magnetic resonance imaging (MRI) to visualize the anatomy of the hand, assess for fractures or joint injuries, and evaluate the extent of tendon damage or rupture. 8. Neurovascular Examination Conduct a thorough neurovascular examination to assess sensory function (light touch, twopoint discrimination) and vascular status (capillary refill, pulse palpation) in the affected hand. Document any sensory deficits or vascular abnormalities. 9. Functional Assessment Assess functional deficits related to hand injuries, such as difficulties with fine motor tasks, grasping objects, or performing activities of daily living (ADLs). Functional testing provides valuable information on the impact of tendon injuries on overall hand function and guides rehabilitation goals. Documentation and Follow-up Document findings from the examination, including range of motion measurements, strength testing results, presence of special test findings, and any relevant imaging results. Develop a treatment plan based on the assessment findings, which may include splinting, physical therapy, or surgical intervention for tendon repair or reconstruction. Follow-up evaluations are essential to monitor progress, adjust treatment as needed, and optimize recovery of hand function.