Inspection:
1.Hand
Wasting of thenar muscles , pointing index (Median N. injury)
Wasting of hypothenar muscles, interosseous muscles, claw hand (Ulna N. injury)
Wrist /finger drop (Radial n. injury)
Trophic changes

2.Wrist:
scars

3.Forearm:
muscle wasting anterior forearm (Median n)
posterior forearm (radial N)

4.Elbow
valgus deformity (Tardy ulnar n.)
Palpable ulna N (Leprosy look for other signs of leprosy- collapse nasal
bridge,hypopigmented patch etc)

5.Shoulder
-Deltoid wasting (Brachial plexus injury- look for other signs)

Palpation
1.Sensation loss
-Examine the autonomous sensory area of each nerve
-tip of index (Median N)
-tip of little finger (Ulna N.)
OR
-Medial 11/2 (Ulnar N.)
-Lateral 31/2 (Median N.)
-Anatomical snuff box (Radial N)

2.Power
-Index & middle finger flexors weakness (Median N)
-Thumb abductor
-abductor digiti minimi weakness (Ulnar n)
-MCP,thumb and wrist extensor weakness (radial n)

Secial tests:
-Benediction test (Median n)
-Froment’s sign (Ulna n)

Labels: Short cases in orthopaedics