When examining the flexor and extensor tendons of the hand, the inspection should take into consideration:

  • Hand position – look for the normal cascade
  • Symmetry
  • Deformities
  • Swelling, colour, wounds (fig 1), wasting, scars

What is the aim of palpation?

Palpation should:

  • Localise tenderness: bony and soft tissue
  • Define the characteristics of the swelling

What should be examined in terms of range of motion?

Active and passive range of motion should be examined, and the range of motion against manual resistance to strength:

  • Finger flexion at MCP, PIP, DIP joints
  • Finger extension at MCP, PIP, and DIP joints
  • Finger abduction
  • Finger adduction
  • Thumb flexion
  • Thumb extension
  • Thumb abduction
  • Thumb adduction
  • Opposition of thumb to little finger
  • Functional grip tests
  • Pinch tests

What neurovascular examinations should be undertaken?

Neurovascular examinations should include:

  • Regional pulses, capillary refill
  • Test sensation

What special tests are there?

Special tests include:

  • FDS, FDP, FPL, EPL testing
  • Extensor tendon testing for mallet finger
  • Elson’s test
  • Ligamentous instability test of the thumb

When should you x-ray?

X-ray when a fracture, a penetration injury, or a foreign body are suspected.