Hand

Question 1

1. General Inspection

Answer 1

Splints
Walking aids
Signs of pain
Body habitus 
Systemically well

Question 2

2. Look

Answer 2

Deformity
Skin changes
Wasting
Swelling
Nail changes
Wrist
Elbow

Question 3

3. Deformity

Answer 3

Rheumatoid arthritis
Swan neck
Boutonierres
Z thumb
Ulnar deviation
Subluxation of MCPJs

Question 4

4. Skin changes

Answer 4

Thinning or bruising (steroids)
Palmar erythema (RA)
scars

Question 5

5. Wasting

Answer 5

1st dorsal interossei
Thenar eminence
Hypothenar eminence

Question 6

6. Swelling

Answer 6

Herberdens/Bouchards nodes (OA)
Boggy swelling (synovitis - RA trauma)
Cystic swelling - ganglion

Question 7

7. Nail changes

Answer 7

Pitting, oncholysis (psoriatic arthritis)

Nail fold infarcts(vasculitis)

Question 8

8. Wrist (look)

Answer 8

Deformity - subluxation, deviation
Skin changes - scars (carpal tunnel release)
Swelling - RA nodules, ganglion, gouty tophi

Question 9

9. Elbow (look)

Answer 9

Psoriatic rashes
RA nodules
Gouty tophi

Question 10

10. Feel

Answer 10

Temperature
Hand
Phalangeal Joints
Wrist

Question 11

11. Hand (feel)

Answer 11

Wasting of thenar/hypothenar eminences
Thickening of flexor tendons (dupuytren’s)
Anatomical snuff box tenderness (#scaphoid)

Question 12

12. Phanlangeal joints (feel)

Answer 12

MCP Squeeze
Each PIP, DIP
Base of thumb

Question 13

13. Wrist (feel)

Answer 13

Ulnar border
Ulnar head (extensor capri ulnaris tendonitis -RA)
Radial styloid process (?de Quervain’s tenosynovitis)

Question 14

14. Move

Answer 14

Grip strength
Fingertips to thumbs
Pick up something small
Fingers - flexion, extension, abduction, adduction
Thumb - flexion, extension, abduction, adduction, opposition
Wrist - flexion, extension, radial/ulnar deviation, supination, pronation

Question 15

15. Special Tests

Answer 15

Phalen’s (upside down prayer) - tingling = carpal tunnel syndrome
Froment’s (paper grip) - pinch grip = ulnar nerve palsy

Question 16

16. Neurovascular

Answer 16

Radial/ulnar pulses, capillary refill
Radial - Cock wrist, don’t let me push down (thumb)
Ulnar - don’t let me push little finger in (little finger)
Median - thumb to little finger, don’t let me break it (middle finger)