Ideal Examination Of Hand

Courtesy: Dr. Abijit Wahegaonkar, Dr Ashok Shyam, Ortho TV

 

Hand Neurological Examination 

Topic / Overview

The three major nerves to assess in the hand are:

• Median nerve
• Ulnar nerve
• Radial nerve

1. General Neurological Examination of the Hand

Neurological examination – Motor + Sensory

For each nerve, assess:

• Muscle function
• Muscle power
• Sensory distribution
• Autonomous sensory area
• Specific signs/tests where relevant

2. Median Nerve

• Median nerve motor function
• Opposition
• Median sensory supply
• Autonomous sensory area
• Carpal tunnel examination

Motor Function

The most clearly identifiable motor function is:

Thumb opposition

refers to opposition as an important function that should be assessed during hand examination.

Because the remaining motor details are corrupted, additional median-nerve muscles should not be inserted from outside knowledge.

Sensory Examination

3. Ulnar Nerve

The ulnar nerve receives particular emphasis.

refers to:

• Ulnar motor supply
• Interossei
• Sensory supply to the ulnar digits
• Autonomous sensory area
• Ulnar paradox
• Proximal versus distal ulnar nerve lesions

Motor Examination

appears to emphasize the intrinsic muscles of the hand, particularly the:

• Interossei

4. Ulnar Sensory Distribution

clearly associates the ulnar nerve with sensory supply to the:

• Little finger
• Ulnar side of the ring finger / ulnar digits

also identifies the little finger as an important autonomous sensory area for the ulnar nerve.

5. Ulnar Paradox

This is one of the clearest concepts preserved.

asks:

“What is the paradox?”

The intended topic is clearly the ulnar paradox.

contrasts:

• Proximal ulnar nerve lesion
• Distal ulnar nerve lesion

and states that the deformity/clawing is more prominent with the distal lesion, while a more proximal lesion produces less obvious deformity.

Core concept from source

The more distal the ulnar nerve lesion, the more prominent the clawing; a proximal lesion produces less obvious clawing.

This inverse relationship between level of lesion and degree of visible clawing is the ulnar paradox.

6. Radial Nerve

The radial nerve section is comparatively clear.

describes its motor function mainly through the extrinsic extensors arising in the forearm.

Motor functions mentioned include:

• Wrist extension
• Digit extension

Thus, radial nerve assessment in the hand should include the ability to extend the wrist and fingers.

7. Radial Nerve Sensory Examination

refers to:

• Radial sensory distribution
• An autonomous sensory area

However, the exact anatomical site of the autonomous zone is not clearly preserved in the supplied transcript, so it should not be specified without an external source.

8. Comparison of the Three Major Nerves

Nerve	Main motor feature	Sensory point
Median nerve	Thumb opposition	Median sensory distribution mentioned, exact area unclear
Ulnar nerve	Intrinsic hand function/interossei	Little finger emphasized as autonomous area
Radial nerve	Wrist and digit extension	Autonomous zone mentioned, exact site unclear

9. Ulnar Nerve — Proximal vs Distal Lesion

Feature	Proximal ulnar lesion	Distal ulnar lesion
Level	More proximal	More distal
Visible clawing	Less prominent	More prominent
Concept	Part of ulnar paradox	Part of ulnar paradox

Exam Pearl

More distal lesion – more obvious clawing.

This is the key relationship emphasized in the lecture.

10. Carpal Tunnel Examination

Tinel’s, Phalen’s, Durkan’s,

11. Motor Power Assessment

Each nerve should be assessed by testing a representative motor function and grading its power systematically.

12. Sensory Examination Principle

The sensory examination should include:

• Comparison between sides
• Identification of nerve-specific sensory territory
• Testing of the autonomous zone where possible

particularly emphasizes autonomous sensory areas because they help identify an isolated peripheral nerve lesion.

13. Suggested Practical Examination Sequence From the Lecture

The recognizable material can be reorganized into the following sequence:

Step 1 — Inspection

Step 2 — Motor examination

Assess representative functions of:

• Median nerve – opposition
• Ulnar nerve – intrinsic/interosseous function
• Radial nerve – wrist and digit extension

Step 3 — Grade muscle power

Use a standardized muscle-power grading system.

Step 4 — Sensory examination

Assess nerve-specific sensory distribution and autonomous zones.

Step 5 — Special signs

Particularly:

• Ulnar paradox
• Carpal tunnel provocative tests

14. Possible Additional Instability Examination

joint instability examination,

Practical Clinical Implications

A neurological hand examination should not simply ask whether the patient can move the fingers.

practical approach is:

Identify the nerve – test a representative motor function – grade power – examine sensory territory/autonomous zone – look for characteristic nerve-specific signs.

The three major nerves to systematically assess are:

Median – Ulnar – Radial

Key Take-Home Points

• Complete neurological examination of the hand is divided into motor and sensory examination.
• The three major peripheral nerves emphasized are median, ulnar and radial.
• Median nerve: opposition is an important motor function to assess.
• Ulnar nerve: intrinsic/interosseous function is important.
• Little finger is emphasized as an autonomous sensory area for the ulnar nerve.
• Radial nerve: assess wrist extension and finger extension.
• Sensory examination should include autonomous nerve territories.
• Distal ulnar lesion – more prominent clawing.
• Proximal ulnar lesion – less prominent clawing..

Exam Pearls

Median nerve – Opposition

Ulnar nerve – Interossei / intrinsic hand muscles

Radial nerve -Wrist + finger extension

Ulnar autonomous zone – Little finger

Ulnar paradox -distal lesion produces greater clawing than proximal lesion

For viva, follow a fixed sequence:

Inspection – Motor – Power grading – Sensory examination – Autonomous zone – Special tests