Clinical skills: hand examination

Question 1

What do we look for in the forearm and elbow?

Answer 1

Psoriatic plaques

Rheumatoid nodules

Question 2

What do we look for in the skin?

Answer 2

Thinning and bruising - use of steroids

Thickening (sclerodactyly) - systemic sclerosis

Question 3

What do we look for in the joints?

Answer 3

Ulnar deviation (at MCPs)
Swan neck / Boutonniere deformity (digits)
Z-shaped thumbs

Question 4

What do we look for in the nails?

Answer 4

Pitting and oncholysis (psoriasis)

Nailfold vasculitis

Question 5

What do we palpate in the hands?

Answer 5

• Feel joints for warmth
• Squeeze MCPs for tenderness
• Palpate joints for synovitis (boggy) / osteoporosis (bony)

Question 6

How is hand function assessed?

Answer 6

• Prayer & reverse (flexion / extension)
• Make a fist
• Pincer grip - pull
• Fine pinch (pick up coin)
• Tripod grip (hold pen)
• Power grip (squeeze fingers)
• Hook grip