Hand Flashcards
Scleroderma - Hand findings (9)
Hand function Raynauds Sclerodactyly, difficulty flexing fingers Telengiectasia Calcinosis Atrophy of distal tissue pulp/pseudo-clubbing Fingertip ulceration Tendinitis Nails: dilated capillary loops
Scleroderma - Face
Bird like face Skin changes may extend to neck Telengiectasia Dry mouth, eyes Reduction in mouth aperture Alopecia
Scleroderma - Abdomen
Liver involvement (uncommon, PBC) PEG tube in severe oesophageal disease
Scleroderma - lower limbs
Proximal myopathy
Vasculitis
Peripheral ulceration
Amputations
Osteoarthritis - what additional findings should you look for?
Nodal OA hands - Other joints eg. Shoulder, neck, hips, knees
Osteoarthritis - If 2nd/3rd MCP joints are predominant, what is this suggestive of?
Haemochromatosis
What are the hand findings in dermatomyositis?
Gottren's sign - Scaly erythematous Heliotrope rash (violaceous) Shawl sign Mechanics hands (Rough cracked skin finger tips/lateral aspects) Calcinosis usually only in kids
Must proceed to Neuro Power and Respiratory Examination
Outline the back examination
- Look
- Must ask the patient to undress to shorts and be standing
- Rash - psoriasis
- Deformity - kyphosis, lumbar lordosis - Palpation - palpate down the back
- - Vertebral bodies for tenderness
- - Muscle spasm
- - SI joint testing
- - Achilles tendonitis/plantar fasciitis - Movements
- - Modified Schober’s test
- - Lateral flexion: fingers to floor
- - Thoracic rotation
- - Passive neck movements - Measurement
- - Occiput to wall
- - Chest expansion
Back and proceed.. What should you proceed to?
Lungs - apical fibrosis Heart - AR (or AVR!), MVP Eyes - Uveitis Peripheral joints Stools (IBD) Urine (Amyloid)
Scleroderma - after the hands
Skin changes - thickened, coarse hyperpigmentation, vitiligo, telengiectasia
Upper limbs -
- Proximal disuse atrophy
- Myositis
Blood pressure
Chest -
- Cardiovascular examination (CCF, Cardiomyopathy, myocardial fibrosis, pulmonary hypertension, RVH)
- Resp examination (Pulmonary fibrosis, pleurisy/rubs)
What are the typical radiological features of osteoarthritis on plain film?
Joint space narrowing Subchondral sclerosis Subchondral cysts Osteophytosis Joint erosions
What are the typical features of Rheumatoid arthritis on plain film?
Subchondral cysts
Subluxation causing ulnar deviation of MCP joints, swan neck and boutonniere deformities
Joint space narrowing
Periarticular erosions
Periarticular osteopaenia
Erosion of dens (atlantoaxial subluxation)
What are the typical features of gout on plain film?
Chondrocalcinosis (calcium deposits within articular cartilage)
Joint effusion
“Punched out” erosions
Tophi (pathognomonic)
Preservation of joint space (until very late in the disease course)
Absence of periarticular osteopaenia
What are possible DDx for gout?
Calcium pyrophosphate crystal deposition disease
Dactylitis
RA with rheumatoid nodules
Trauma
What are the typical findings of Psoriatic arthritis on plain film?
“Pencil in cup” - enthesitis + marginal bone erosions
Dactylitis - sausage digit
