Physical Examination 214: Wrist, Hand and Thumb

The orthopedic and neurologic examination of the wrist, hand and thumb, test by test and on video. The thumb first: its seven motions, the Gamekeeper's (Skier's) test for ulnar collateral ligament rupture and the grind test for carpometacarpal osteoarthritis. Then De Quervain tenosynovitis with Eichhoff's active and passive tests and the three-step Finkelstein's test; the hook of hamate pull test and when to image; the Elson, Bunnell-Littler, Watson scaphoid shift and TFCC compression tests; the examination findings and clinical criteria for osteoarthritis and the hand deformities of rheumatoid arthritis; intersection syndrome; the drop wrist, claw hand, benediction and ape hand postures and the nerve behind each; the carpal tunnel battery of Tinel's, Durkan compression, modified compression, Phalen's and reverse Phalen's; pronator teres syndrome and how to tell it from carpal tunnel; and the Wartenberg and Froment's signs for Guyon's canal syndrome.

Donald Ozello, DC, CCN, CCSM — sports chiropractor and NSCA Certified Personal Trainer — teaches the 2-hour course. It is written for Doctors of Chiropractic who see hands: the athlete with a jammed thumb or a sore hypothenar eminence, the patient with radial wrist pain who pinches for a living, the night-time numbness that may or may not be carpal tunnel. Each test is shown on video with the patient and doctor positions, the maneuver, the positive finding and what it indicates.

With Eichhoff's test and Finkelstein's test, and the course shows both on video. For Eichhoff's, the patient makes a fist with the thumb tucked inside and either actively ulnar-deviates the wrist or the doctor does it passively; radial-sided wrist pain is positive. Finkelstein's test is taught in three steps so it can be graded to the patient's irritability: first the patient lets gravity carry the wrist into ulnar deviation, which is suitable in the acute phase; second the doctor very gently ulnar-deviates the wrist passively; third the doctor very gently flexes the thumb. Pain over the radial wrist at any step is positive for De Quervain tenosynovitis, a thickening of the abductor pollicis longus and extensor pollicis brevis tendons from repetitive deviation and thumb extension, typically worse with pinch grasp. The course also teaches the look-alike to rule out — intersection syndrome, where the pain and a palpable crepitus sit a few centimeters proximal to the radial styloid at the crossover of the first and second dorsal compartments, and resisted pronation, wrist extension and thumb extension reproduce it.

Physical Examination 214 is online and on-demand: you start immediately after checkout and work at your own pace. When you pass the post-course assessment your completion is recorded electronically and your certificate is issued right away. CCEDseminars is PACE Provider #34015544 and the course is co-sponsored by Texas Chiropractic College; completions are reported to CE Broker for the states served. Approved states are listed at the bottom of this page, and confirming your own board's requirements remains your responsibility.

Dr. Ozello's other upper-quarter examinations — Physical Examination 209: Shoulder Complex, 210: Upper Extremity and 211: Upper Body Nerve Entrapment — complete the arm from shoulder girdle to fingertips, and any three of the four courses are 6 CE hours, where the automatic 10% multi-course discount starts ($108 instead of $120). The treatment side of the same region is his Adjusting & Manual Therapy 205: Upper Extremity Techniques, and carpal tunnel, Guyon's canal and pronator syndromes continue on the injury side in Sports Injuries 239 and 242: Upper Extremity Nerve Entrapments. New Physical Examination titles are released as faculty complete them; the current list with pricing lives on the category page.