Hand Examination Flashcards
What are you looking for in a nail investigation of the hand
Splinter haemorrhages
Nail pitting and onycholysis
Clubbing
Name the possible causes of splinter haemorrhages
Infective endocarditis
Local trauma
Sepsis
Vasculitis
Psoriatic nail disease
Name the possible causes of nail pitting and onycholysis
Psoriasis and psoriatic arthritis
Name the osteoarthritis signs in the hand
Heberden’s nodes
Bouchard’s nodes
Name the rheumatoid arthritis signs in the hand
Boutonnieres deformity
Swann-neck deformity
Z-thumb
Describe boutonnieres deformity, what is it a sign of
PIPJ flexion with DIPJ hyperextension
Rheumatoid arthritis
Describe Heberden’s nodes, what is it a sign of
At distal interphalangeal joints (DIPJ)
Osteoarthritis
Describe Bouchard’s nodes, what is it a sign of
At proximal interphalangeal joint (PIPJ)
Osteoarthritis
Describe Swann-neck deformity, what is it a sign of
Distal interphalangeal joint (PIPJ) - include DIPJ flexion with PIPJ hyperextension
Rheumatoid arthritis
Describe Z-thumb, what is it a sign of
Hyperextension of interphalangeal joint + fixed flexion and subluxation of metacarpophalangeal joint (MCPJ)
Describe dupuytrens contractures
Involve thickening of palmar fascia
Results in development of cords of palmar fascia which eventually cause contracture deformities of finger and thumb
Describe thenar/hypothenar wasting
Isolated wasting in the thenar eminence - suggestive of median nerve damage (carpal tunnel syndrome)
What in the hand can be a sign of carpal tunnel syndrome
Thenar/hypothenar wasting
Describe Janeway lesions
Non-tender, haemorrhagic lesions that occur on the thenar and hypothenar eminence of the palmar (and soles)
Typically associated with infective endocarditis
Describe osler nodes
Red-purple, slightly raised tender lumps, often pale centre
Typically found on fingers and toes
Associated with infective endocarditis
On a hand examination what are you looking for on the elbows
Inspect for evidence of psoriatic plaques or rheumatoid nodules
On a hand examination summarise the findings which may show OA
Herbens and Bouchard’s nodes - represent osteophyte formation.
Often associated with crepitus and reduced range of motion
On a hand examination summarise the findings which may show RA
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
Describe on a hand examination findings suggestive of psoriatic arthritis
Inflammation of joints and surrounding tissue
Joint swelling and pain, dactylitis (swelling of whole digits)
What are the causes of thenar and hypothenar eminence wasting
Diffuse atrophy
LMN lesions (ulnar and median nerve)
Where do you check median nerve sensation
Thenar eminence and index finger
Where do you check ulnar nerve sensation
Hypothenar eminence and little finger
Where do you check radial nerve sensation
Sensation over the first dorsal webspace
Tenderness of the metacarpophalangeal joint is suggestive of..
Active inflammatory arthropathy
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
Name the 4 active movements in a hand examination
(Performed independently by the patient)
- Finger extension - open and display fingers
- Finger flexion - make a fist
- Wrist extension - normal range of movement 90 degrees - pray sign
- Wrist flexion - opposite of above
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
What 3 nerves are being assessed in the motor function portion of a hand examination
Radial
Ulnar
Median
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
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
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
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
Name the special tests in a hand examination
Tinel’s test
Phalen’s test
Describe Tinel’s test
Identify median nerve compression - useful to add on for carpal tunnel syndrome
Tap over the carpal tunnel with fingers
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
