Skip Navigation HRSA - U.S Department of Health and Human Services, Health Resources and Service Administration HHS
Home
Questions
Order Publications
 
Grants Find Help Service Delivery Data Health Care Concerns About HRSA

Hansen's Disease

 

Hand Screen Form

Section I. SENSORY TESTING

Use first filament (A) at site indicated (apply  three times):  If no response, use next heavier filament to determine level of loss.

Sensory Testing Section of the Hand Screen
Filament force, gm Interpretations & Marking Numbers Points
A (Green) 0.05 Normal  (2.83) 5
B (Blue) 0.20 Residual Texture  (3.61) 4
C (Purple) 2.00 Residual Protective Sensation (4.31) 3
D (Red) 4.00 Loss of Protective Sensation  (4.56) 2
E (Orange) 300.00 Residual Deep Pressure  (6.65) 1

Section II.  SKIN INSPECTION:

Draw  and label (above) :   W - Wound,  C - Callus,  S - Swelling,  R - Redness,  D - Dryness,  T - Temperature, M - Missing,  J - Contracture,  O - Other

Section III. MUSCLE TESTING: Mark (below):  S = Strong, W = Weak, P = Paralysis
 (or Grade 5 to 0)

                          (Ulnar Nerve)         (Median Nerve)    (Radial Nerve)

Muscle Testing Section - Index Finger Abduction (FDI)

Muscle Testing Section - Little Finger - MP Joint Flex (L)

Muscle Testing Section - Thumb Abduction - Out of Palm (APB)

Muscle Testing Section - Radial Wrist Extension (ECR)

Muscle Testing Section - Thumb to Little Finger (OP)

R ____  L ____

R ____  L ____

R ____  L ____

R ____  L ____

R ____  L ____

1) Index finger Abduction (FDI) 2) Little finger MP Joint Flex. (L) 3) Thumb Abduction Out of Palm (APB) 4) Thumb to Little Finger (OP) 5) Radial Wrist Extension (ECR)
Section IV.  PERIPHERAL NERVE RISK:   
 Mark: U = Ulnar, M = Median, R = Radial, (or UM)

Peripheral Nerve Risk Section of Hand Screen

 1) Enlarged or swollen nerve R ____    L____
2) Tender / painful on stretch or compression R ____    L____
3) Sensory change in the last 12 months R ____     L____
4) Muscle change in the last 12 months R ____     L____
High Risk (acute or changing nerve)  (refer to physician / therapist) Yes ___  No ___
Section V. DEFORMITY RISK: (check if present)

1) Loss of Protective Sensation R ___  L ___ 4) Injuries (wounds, blisters, etc.) R ___  L ___
2) Clawed but Mobile Hand R ___  L __ 5) Contracted or Stiff Joints R ___  L ___
3) Fingertip Absorption          (Mild__   Severe__) R ___  L ___ 6) Wrist Drop (radial nerve) R ___  L ___

High Risk (any of the above) :
(refer for appropriate treatment) 		Yes ___  No ___

Has there been a change in the hand since last exam ?     Yes ____  No ____