Hand examination

Question 1

what do you check the skin for

Answer 1

sclerodactyly, signs of steroid use, scarring

Question 2

what do you check the nails for

Answer 2

psoriatic changes, pitting, onycholysis, nail fold infarcts

Question 3

what deformities do you check for

Answer 3

Dupuytren’s contracture, mallet finger, gouty tophi, clawing (ulnar neuropathy)

Question 4

what do you check the fingers for

Answer 4

MCPJs – swelling or ulnar deviation (RA)

Swelling at PIPJs – Bouchard’s nodes (RA and OA)

Swelling at DIPJs – Heberden’s nodes (OA)

Digit deformity associated with rheumatoid arthritis –
swan neck deformity, Boutonniere deformities, Z-shaped thumb

Muscle wasting – interossei, thenar and hypothenar eminence

Question 5

what do you check the wrist and elbow for

Answer 5

swelling (synovitis), rheumatoid nodules, psoriatic plaques

Question 6

feel

Answer 6

Feel for warmth at wrist and MCPs Squeeze MCPs, noting any tenderness
Bimanually palpate any swollen joints to assess whether synovitic (soft, ‘boggy’ swelling) or bony (hard swelling)

Question 7

move

Answer 7

Ask the patient to open and close the fist – note any reduced range of movement, triggering or deformity
Finger extension and flexion Finger abduction and adduction Thumb opposition

Question 8

tests for RA

Answer 8

• power of pincer grip
• fine pinch (picking up a coin)
• chuck or tripod grip (holding a pen)
• power grip (squeezing your fingers)
• hook grip (resisting decoupling of your hooked hands when
  pulling away)

Question 9

tests for hand injury

Answer 9

Capillary refill time
Check nerves distal to the injury Check tendons are intact Compare both sides

Question 10

tests for neurological symptoms

Answer 10

Test sensation and power in radial, ulnar and median nerve distribution