Hand

Question 1

Look: (at both hands)

Answer 1

-Skin- colour, scars
-Nails- splinter haemhorages, tar staining, oncholysis ? psoriatic arthritis
-dactilysis (sausage fingers)- psoriatic arthritis
-Nodes- Bouchards and Heberden’s nodes
-Oslers nodes- purple > Infective Endocarditis
-Boutinnieres deformity
-Swan neck deformity
-thenar muscle wasting- carpal tunnel syndrome
-scaphoid fracture

Question 2

Feel (both hands)

Answer 2

Use both hands to feel each finger

-Temperature, cap refill
-Feel all individual joints of the hands
-Observe for tenderness
-Palmar and Dorsal Aspect of the hand
-Palpate radial pulse

Phalanges (use 2 fingers to feel each finger)
-thenar muscle- wasting and pain
-Proximal, inter, distal (PIP, IP,PIP)
-Carpals- MCP. CMC

Question 3

Move (compare both sides)

Answer 3

1) Open and close the fist
open hands- apply pressure downwards to test flexion
2) Finger Extension- splay fingers

*apply pressure with one finger to splayed fingers adduction and abductionto test strength
3) Finger Flexion- make a fist
4) Finger Abduction- separate
5) Finger Adduction- together

RA Assessment: Movements
-Power pincer grip with paper (use 2 fingers)
-link my fingers
-Fine pinch-coin
-Hold a pen
-Power grip- grip both hands together
-Hook grip- with doctor

SQUEEZE THEIR HAND detect pain

Question 4

What does each Bouchards and Oslers nodes indicate?

Answer 4

Bouchards- RA and OA (proximal PIP)
Heberden’s- OA (Distal as Heberdies mountains are far)
-Swan neck deformities

Question 5

Name signs that indicate mallet finger, Dupytren’s Contracture and Scaphoid Fracture.

Answer 5

Scaphoid Fracture:
-Pain when pressure is applied to the thumb
-Pressure is applied to the anatomical snuffbox

Mallet Finger:
-end finger is bent down

Dupuytren’s Contracture:
-finger bent towards palm hand and can’t flatten