Hand Examination Flashcards

1
Q

What are you looking for in a nail investigation of the hand

A

Splinter haemorrhages
Nail pitting and onycholysis
Clubbing

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2
Q

Name the possible causes of splinter haemorrhages

A

Infective endocarditis
Local trauma
Sepsis
Vasculitis
Psoriatic nail disease

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3
Q

Name the possible causes of nail pitting and onycholysis

A

Psoriasis and psoriatic arthritis

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4
Q

Name the osteoarthritis signs in the hand

A

Heberden’s nodes
Bouchard’s nodes

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5
Q

Name the rheumatoid arthritis signs in the hand

A

Boutonnieres deformity
Swann-neck deformity
Z-thumb

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6
Q

Describe boutonnieres deformity, what is it a sign of

A

PIPJ flexion with DIPJ hyperextension

Rheumatoid arthritis

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7
Q

Describe Heberden’s nodes, what is it a sign of

A

At distal interphalangeal joints (DIPJ)

Osteoarthritis

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8
Q

Describe Bouchard’s nodes, what is it a sign of

A

At proximal interphalangeal joint (PIPJ)

Osteoarthritis

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9
Q

Describe Swann-neck deformity, what is it a sign of

A

Distal interphalangeal joint (PIPJ) - include DIPJ flexion with PIPJ hyperextension

Rheumatoid arthritis

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10
Q

Describe Z-thumb, what is it a sign of

A

Hyperextension of interphalangeal joint + fixed flexion and subluxation of metacarpophalangeal joint (MCPJ)

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11
Q

Describe dupuytrens contractures

A

Involve thickening of palmar fascia

Results in development of cords of palmar fascia which eventually cause contracture deformities of finger and thumb

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12
Q

Describe thenar/hypothenar wasting

A

Isolated wasting in the thenar eminence - suggestive of median nerve damage (carpal tunnel syndrome)

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13
Q

What in the hand can be a sign of carpal tunnel syndrome

A

Thenar/hypothenar wasting

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14
Q

Describe Janeway lesions

A

Non-tender, haemorrhagic lesions that occur on the thenar and hypothenar eminence of the palmar (and soles)

Typically associated with infective endocarditis

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15
Q

Describe osler nodes

A

Red-purple, slightly raised tender lumps, often pale centre

Typically found on fingers and toes

Associated with infective endocarditis

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16
Q

On a hand examination what are you looking for on the elbows

A

Inspect for evidence of psoriatic plaques or rheumatoid nodules

17
Q

On a hand examination summarise the findings which may show OA

A

Herbens and Bouchard’s nodes - represent osteophyte formation.

Often associated with crepitus and reduced range of motion

18
Q

On a hand examination summarise the findings which may show RA

A

Symmetrical joint inflammation - typically affecting the proximal interphalangeal joint, metacarpophalangeal joint, wrist joint

Features of muscle wasting, ulnar deviation, Swann neck deformity, Boutonnieres deformity and z-thumb deformity

19
Q

Describe on a hand examination findings suggestive of psoriatic arthritis

A

Inflammation of joints and surrounding tissue

Joint swelling and pain, dactylitis (swelling of whole digits)

20
Q

What are the causes of thenar and hypothenar eminence wasting

A

Diffuse atrophy
LMN lesions (ulnar and median nerve)

21
Q

Where do you check median nerve sensation

A

Thenar eminence and index finger

22
Q

Where do you check ulnar nerve sensation

A

Hypothenar eminence and little finger

23
Q

Where do you check radial nerve sensation

A

Sensation over the first dorsal webspace

24
Q

Tenderness of the metacarpophalangeal joint is suggestive of..

A

Active inflammatory arthropathy

25
What is tenderness in the anatomical snuffbox suggestive of
Scaphoid fracture Largest bone in the proximal carpal bones Most commonly fractured Occurs due to a fall on outstretched hands Slow blood supply can lead to delay healing and avascular necrosis
26
Name the 4 active movements in a hand examination
(Performed independently by the patient) 1. Finger extension - open and display fingers 2. Finger flexion - make a fist 3. Wrist extension - normal range of movement 90 degrees - pray sign 4. Wrist flexion - opposite of above
27
Name the 4 passive movements in hand examination
(Movement of patient is controlled by the examiner) Look for crepitus, and restricted range of movement (OA). Discomfort of restriction pin joints range of movement Fully relax. Tell about pain immediately Repeat the active movements
28
What 3 nerves are being assessed in the motor function portion of a hand examination
Radial Ulnar Median
29
How do you test radial nerve examination as part of a hand examination
Muscle = extensors of the wrist and fingers Arms out in front with palms facing the ground Extend fingers, cock wrists back and dont let push down
30
How do you test ulnar nerve examination as part of a hand examination
Muscle = index finger aBduction against resistance (fist dorsal interosseous) Splay fingers - dont let push together. Apply resistance to index finger with own index finger
31
How do you test median nerve examination as part of a hand examination
Muscle = abductor pollicis brevis (thumb aBduction against resistance) Hand upwards, thumb in middle of palm - point thumb to celling dont let push it down
32
What function test are part of a hand examination
Power grip - squeeze fingers with hand Pincer grip - squeeze finger between thumb and index finger Pick up a small object
33
Name the special tests in a hand examination
Tinel's test Phalen's test
34
Describe Tinel's test
Identify median nerve compression - useful to add on for carpal tunnel syndrome Tap over the carpal tunnel with fingers
35
Describe Phalen's test
Help with further diagnosis of carpal tunnel syndrome Hold wrist with maximum forced flexion for 60 seconds If symptoms of carpal tunnel = positive