9. Hand Flashcards
Osteoarthrtiis signs in the hands
heberden’s nodes (in the DIP joints)
Bouchard’s nodes (in PIP joints)
Squaring at the base of the thumb at carpo-metacarpal joint
Weak grip
Reduced range of motion
Intro to hand exam
INTRO AND FUNCTION
“This will involve me having a look at your hands, feeling the small joints and asking you to do some movements… does that sound okay?” “I will also be testing the sensation in your arms and hands and checking your pulses in your wrist…”
“do you have any pain in your hands or wrist atm? have you git any numbness or tingling”
“let me know if you get any pain or if anything is uncomfotable during the examiantion…”
“just to get a bit of background, can i ask what hand do you write with? are you able to do fine movements such as doing up buttons…?”
“show mw how you hold this pen normally… and in the other hand. grip my fingers, grip pen and dont let me pull it away”
rheumatoid arthritis signs in the hands
Palpation of synovium wll give a “boggy” feeling
Z shaped deformity of the thumb
Swan neck deformity (flexed DIP with hyperextended PIP)
Boutonnieres deformity (hyperextended DIP with flexed PIP)
Ulnar deviation of the fingers at the knuckle (MCPs)
spceial test for de quervains tenosynovitis
Finkelstein’s test
Finkelstein’s test (or maybe Eichhoff’s test) involves the patient making a fist with their thumb inside their fingers. Then, the wrist is adducted (ulnar deviation), causing strain on the APL and EPB tendons. If this movement causes pain at the radial aspect of the wrist, the test is positive, indicating De Quervain’s tenosynovitis.
test dupytrens contracture
The table-top test is a straightforward test for Dupuytren’s contracture. The patient tries to position their hands flat on a table. If the hand cannot rest completely flat, the test is positive, indicating Dupuytren’s contracture.
hand signs psoriatic arthritis
Plaques of psoriasis on the skin
Pitting of the nails (nail pitting)
Onycholysis, separation of the nail from the nail bed
Dactylitis, inflammation of the full finger
Enthesitis, inflammation of the entheses, which are the points of insertion of tendons into bone
numbering the digits
1 = thumb coz only 1 of them
Metacarpal I – Thumb.
Metacarpal II – Index finger.
Metacarpal III – Middle finger.
Metacarpal IV – Ring finger.
Metacarpal V – Little finger
bones of the hand
Fingers
(Phalanges)
distal phalange
DIP
medial phalange
PIP
Proximal phalange
MCP
Metacarpals
Thumb
(phalanges)
distal phalanx
IPJ
Proximal phalanx
MCP
metacarpal
CMC
Carapl
Normal function of radial nerve
Motor: “stop”
Extension of wrist, fingers, forearm, thumb
Sensory: area between the dorsal aspect of the 1st and 2nd metacarpals
How may the radial nerve become damaged?
humeral midshaft fracture
How would a damaged radial nerve present?
wrist drop
due to unopposed flexion of the wrist
weakness of thumb extension
Normal function of median nerve
“power to the people”
Motor: LOAF muscles
Lateral lumbicals
Opponens pollicis
Abductor policis
Flexor policis brevis
wrist flexion, finger flexion, thumb opposition, pronation
Sensation : Palmar aspect of lateral 3½ fingers
How does the median nerve become damaged
compression at the wrist (carpal tunnel syndrome)
how would a damaged median nerve present?
general:
weakness of thumb abduction (abductor pollicis brevis)
weakness of finger flexion)
wasting of thenar eminence (NOT hypothenar)
Anterior interosseous nerve: opposition of the thumb and index finger* ‘okay sign’
damage at wrist:
Tinel’s sign: tapping causes paraesthesia
Phalen’s sign: flexion of wrist causes symptoms
damage elbow or higher:
sign of benediction when asked to make a fist (as finger flexion is impaired) if damaged at the elbow or higher as these muscles are further up!
Normal function of ulnar nerve?
“peace sign”
motor: abduction of fingers
Sensory: medial 1 1/2 fingers
adduction of thumb (adductor policis)
How would the ulnar nerve become damaged?
medial epicondyle fracture
How would a damaged ulnar nerve present?
frommets sign (cant adduct thumb properly)
inability to abduct/adduct fingers and adduct thumb
sensory loss over medial 1 1/2 fingers
cubital tunnel syndrome
Tingling and numbness of the 4th and 5th finger which starts off intermittent and then becomes constant.
Over time patients may also develop weakness and muscle wasting
Pain worse on leaning on the affected elbow
Medial epicondyle fracture -
Damage may result in a ‘claw hand’ AT REST due to damage to lateral lumbricals
what nail signs are you looking for hand exam
Pitting and/or nail ridges
Onycholysis
Onychogryphosis
o Splinter haemorrhages, nail fold infarcts
o Clubbing
what is oncholysis, what is it seen in
(separation of the nail from the nailbed e.g. psoriasis, fungal
infection, hyperthyroidism)
what is onchogryphosis, what is it seen in
(hypertrophic nails that resemble horns or claws: may be
post-traumatic or due to peripheral vascular disease)
features of limited cutaenous systemic sclerosis
C – Calcinosis
R – Raynaud’s phenomenon
E – oEsophageal dysmotility
S – Sclerodactyly
T – Telangiectasia
features of diffuse cutaenous systemic sclerosis
Diffuse cutaneous systemic sclerosis includes the CREST features and also affects internal organs, causing:
Cardiovascular problems (e.g., hypertension and coronary artery disease)
Lung problems (e.g., pulmonary hypertension and pulmonary fibrosis)
Kidney problems (e.g., glomerulonephritis and scleroderma renal crisis)
describe scleroderma o/e
Scleroderma refers to the hardening of the skin, giving the appearance of shiny, tight skin without the normal skin folds.
what is sclerodactyly
Sclerodactyly describes the skin changes in the hands. (scleroderma in hands). Skin tightening around the joints restricts the range of motion and reduces function. The fat pads on the fingers are lost. The skin can break and ulcerate.
