Hand

Question 1

what 8 areas are you looking at in a hand examination

Answer 1

skin - sclerodactyly, steroid use, scars
nails - psoriatic changes, nail fold infarcts
deformities - Dupuytren’s contracture, mallet finger, gouty tophi, clawing (ulnar neuropathy)
MCPs - swelling, ulnar deviation (RA)
PIP - swelling (Bouchard’s nodes in RA or OA)
DIP - swelling (Heberden’s nodes in OA)
muscle wasting - interossei, thenar, hypothenar
wrist and elbow - swelling, rheumatoid nodules, psoriatic plaques

Question 2

what are you feeling for in a hand examination

Answer 2

warmth at wrist and MCP
capillary refill
squeeze MCP
nerve sensation
bimanually palpate joints to assess swelling

Question 3

what 8 movements are involved in a hand examination

Answer 3

finger extension and flexion
finger abduction and adduction
thumb opposition to palm and each finger
power of pincer grip
fine pinch grip - pick up coin
chuck or tripod grip - hold pen
power grip - squeeze your fingers
hook grip - resist decoupling of hooked hands

Question 4

describe Hueston’s table top test

Answer 4

ask the patient to place their hand flat on the table
observe their ability to do so - inability suggests Dupuytren’s contracture

Question 5

what other examination should be done along with hand examination

Answer 5

general examination for rheumatoid arthritis
- eyes (episcleritis or scleritis)
- rash (butterfly rash)
- weight loss
- lymphadenopathy