Hand Examination

Question 1

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

Answer 1

Splinter haemorrhages
Nail pitting and onycholysis
Clubbing

Question 2

Name the possible causes of splinter haemorrhages

Answer 2

Infective endocarditis
Local trauma
Sepsis
Vasculitis
Psoriatic nail disease

Question 3

Name the possible causes of nail pitting and onycholysis

Answer 3

Psoriasis and psoriatic arthritis

Question 4

Name the osteoarthritis signs in the hand

Answer 4

Heberden’s nodes
Bouchard’s nodes

Question 5

Name the rheumatoid arthritis signs in the hand

Answer 5

Boutonnieres deformity
Swann-neck deformity
Z-thumb

Question 6

Describe boutonnieres deformity, what is it a sign of

Answer 6

PIPJ flexion with DIPJ hyperextension

Rheumatoid arthritis

Question 7

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

Answer 7

At distal interphalangeal joints (DIPJ)

Osteoarthritis

Question 8

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

Answer 8

At proximal interphalangeal joint (PIPJ)

Osteoarthritis

Question 9

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

Answer 9

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

Rheumatoid arthritis

Question 10

Describe Z-thumb, what is it a sign of

Answer 10

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

Question 11

Describe dupuytrens contractures

Answer 11

Involve thickening of palmar fascia

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

Question 12

Describe thenar/hypothenar wasting

Answer 12

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

Question 13

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

Answer 13

Thenar/hypothenar wasting

Question 14

Describe Janeway lesions

Answer 14

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

Typically associated with infective endocarditis

Question 15

Describe osler nodes

Answer 15

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

Typically found on fingers and toes

Associated with infective endocarditis

Question 16

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

Answer 16

Inspect for evidence of psoriatic plaques or rheumatoid nodules

Question 17

On a hand examination summarise the findings which may show OA

Answer 17

Herbens and Bouchard’s nodes - represent osteophyte formation.

Often associated with crepitus and reduced range of motion

Question 18

On a hand examination summarise the findings which may show RA

Answer 18

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

Question 19

Describe on a hand examination findings suggestive of psoriatic arthritis

Answer 19

Inflammation of joints and surrounding tissue

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

Question 20

What are the causes of thenar and hypothenar eminence wasting

Answer 20

Diffuse atrophy
LMN lesions (ulnar and median nerve)

Question 21

Where do you check median nerve sensation

Answer 21

Thenar eminence and index finger

Question 22

Where do you check ulnar nerve sensation

Answer 22

Hypothenar eminence and little finger

Question 23

Where do you check radial nerve sensation

Answer 23

Sensation over the first dorsal webspace

Question 24

Tenderness of the metacarpophalangeal joint is suggestive of..

Answer 24

Active inflammatory arthropathy

Question 25

What is tenderness in the anatomical snuffbox suggestive of

Answer 25

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

Question 26

Name the 4 active movements in a hand examination

Answer 26

(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

Question 27

Name the 4 passive movements in hand examination

Answer 27

(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

Question 28

What 3 nerves are being assessed in the motor function portion of a hand examination

Answer 28

Radial
Ulnar
Median

Question 29

How do you test radial nerve examination as part of a hand examination

Answer 29

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

Question 30

How do you test ulnar nerve examination as part of a hand examination

Answer 30

Muscle = index finger aBduction against resistance (fist dorsal interosseous)

Splay fingers - dont let push together. Apply resistance to index finger with own index finger

Question 31

How do you test median nerve examination as part of a hand examination

Answer 31

Muscle = abductor pollicis brevis (thumb aBduction against resistance)

Hand upwards, thumb in middle of palm - point thumb to celling dont let push it down

Question 32

What function test are part of a hand examination

Answer 32

Power grip - squeeze fingers with hand

Pincer grip - squeeze finger between thumb and index finger

Pick up a small object

Question 33

Name the special tests in a hand examination

Answer 33

Tinel’s test

Phalen’s test

Question 34

Describe Tinel’s test

Answer 34

Identify median nerve compression - useful to add on for carpal tunnel syndrome

Tap over the carpal tunnel with fingers

Question 35

Describe Phalen’s test

Answer 35

Help with further diagnosis of carpal tunnel syndrome

Hold wrist with maximum forced flexion for 60 seconds

If symptoms of carpal tunnel = positive