Hands

Question 1

Hands LOOK

Answer 1

Erythema - acute infl ie soft tissue infection, septic arth, gout

Nail fold INFARCTS = RA
Telangiectasia - spider veins ie sclero/sle
Psoriasis

MCPJs ?loss of hill and valley = synovitis/swelling
Spindling if inc PIPJs

DEFORMITY
Bony deformities ie rotation
Marfans

FINGER
BOUTONNIERE - flex pip hyperext dip
SWAN NECK - hyperext pip flex dip
UNLAR DEVIATION - MCP sublux
Z THUMB cmc flex, mp hyperext, ip flex

OA NODES - hard osteophytes
HEBERDENS dip
BOUCHARDS pip cmc

TURN OVER
PALMAR ERYTHEMA - RA, cirrhosis, diabetes, pregnancy

Small muscle wasting RA, ulnar palsy T1 = everything!
Thenar = ulnar
Dupytrens
Anterior/volar = partial wrist disloc

WRISTS subluxation ulnar deviation

EXTRA ART - psoriasis/RA NODULES ELBOWS

Question 2

Hands EXTRA ART

Answer 2

EXTENSOR FOREARM = rheumatoid NODULES
Psoriatic PLAQUES

Flexor surface

Dupytrens ie FF
Small muscle/INTEROSSEI wasting - inflam arth, ulnar nerve palsy
THENAR wasting CTS = median
ALL = T1

Palmar eythema
SCARS - CT release, tendon transfer, MCP replacement

Question 3

Hands FEEL

Answer 3

Elbows/ext surfaces EXT ART

PRONATED

MCPJs initial squeeze ?pain ACROSS
Palpate ?spongy
IPJs - palpate above and below ?spongy

Wrists
Palpate ?squaring ie osteophytes cmc

Thumbs JOINTS ANATOMICAL SNUFFBOX

NERVE SUPPLY

SUPINATED
Flexor sheaths - hands/fingers ?swelling ? RUN UP/DOWNtender ?dupytrens

Bony ?OA ie osteophytes OR mucous cysts/tumours
Soft/spongy ?RA/synovitis

DeQuervains tenosynovitis
Abductor pollicus longus/extensor policus brevis - swelling/tender/CREPITUS
Worse wrist/thumb mvt

Radiocarpal joint ?crepitus = OA
FINGER ACROSS FINGER EXTENSORS THEN WRIST EXTENSORS

Question 4

Hands MOVE

Answer 4

ACTIVE
fist to full ext FEEL FOR CREPITUS 
FIST - valleys
Full ext
Wrists FEEL FOR CREPITUS F+E

RESISTED
F+E
Grip
Oposition
Abd 
Add w paper

THUMBS
STRETCH FOR D Q

WRISTS
Prayer and reverse ie 90
Pronate/supinate
Radial/ulnar deviation

PASSIVE
Fingers f+e Elicit TRIGGERING/CREPITUS

FUNCTION ie pick up COIN, turn PAGE

FDP flexor digitorum profundus - flex DIP hold PIP
FDS superficialis - flex PIP v hold other fingers
Extensor digitorum- ext fingers, wrist neutral
Flex ext PL - f e IPJ hold prox phallanx
EPL - ext thumb palm flat

GRIP
OPOSITION

Passive mvt if nec
F e fingers/wrists + deviation

Question 5

Hands NERVE TESTS

Answer 5

Tinels and pharmacy re median nerve CTS

Radial PAPER - wrist and finger extensors
Extend both fully WRIST DROP TRICEPS REFLEX
SENSORY DORSAL AREA below 1-2

Ulnar SCISSORS - hypothenar, interossei, adductor p, FCU
V sign 1 2
DORSAL GUTTERING
Decreased add abd ie card
SENSORY 4-5

Median STONE- thenar ie abd/opose, FDP FDS FCR, palmaris longus, pronator teres
SENSORY 1-3
TINNELS PHALENS 60sec

Median- ant interosseus FPL FDP
OK circle
Clench fist