hand exam

Question 1

Intro to hand exam?

Answer 1

-Wash hands and don PPE
-Introduce yourself with name and role ‘
- explain what the examination will involve
-Position the patient seated with their hands supinated and supported on a pillow
-Ask patient if they have any pain before starting

Question 2

what would you LOOK for?

Answer 2

Pitting and/or nail ridges (seen in psoriasis)
o Onycholysis
o Onychogryphosis
SIGNS OF DISEASE ELSEWHERE
o Splinter haemorrhages, nail fold infarcts e.g. connective tissue disease/
vasculitis
o Clubbing

Question 3

what 4 things would you look for on the dorsum

Answer 3

-SKIN
-SCARS
-MUSCLE WASTING
-DEFORMITY

Question 4

What deformities may be present

Answer 4

• fusiform or local swelling
• swan neck
• bouchards nodes
• wrist swelling

Question 5

what to check on palmar surface

Answer 5

• skin
• scars
• muscle wasting
• deformity

Question 6

what do you check on the elbows

Answer 6

• rheumatoid or arthritic plaques

Question 7

what 4 things do you feel

Answer 7

• temperature , hot or cold , dorsum of hands over areas of redness
  -palpate- for tenderness , swelling or bony deformities
• neuro- check sensation in the dermatomes
  -vascular- radial and ulnar pulse

Question 8

where and how to assess range of motion

Answer 8

FINGERS-
-flexion / extension- ask patient to make a fist then straighten fingers
- abduction/ adduction- extend and spread fingers
THUMB
-flexion, extension,palmar abduction , adduction to opposition