Head to toe- Hands

Question 1

Inspection of nails

Answer 1

• Splinter haemorrhage- endocarditis
• Nail pitting- psoriasis and psoriatic arthritis
• Onycholysis- Psoriasis and psoriatic arthritis
• Finger clubbing- Lung Ca, CF, IBD, bronchiectasis, IE, myxoma
• Leukonychia- trauma, hypoalbuminaemia (end-stage liver disease), chemotherapy
• Kilonychia- IDA (Crohn’s), rheumatic fever

Question 2

Inspect- Dorsal aspect of the hand

Answer 2

• Swelling-
• Skin colour- cellulitis, cyanosis
• Bouchards + Heberdens nodes- OA
• Muscle wasting- lower motor neuron lesion,
  *

Question 3

Inspect- Palmar aspect of the hand

Answer 3

• Swelling
• Dupuytrens contracture- thickening of palmar fascia- occurs in liver disease + diabetes
• Thenar/hypothenar wasting- median nerve damage (e.g. carpal tunnel)
• Janeway lesions- non-tender lesions on palms= IE
• Osler nodes- red tender lumps on fingers/toes= IE
• Palmar erythema- Chronic liver disease + Hyperthyroidism
• Asterixis- CO2 retention + liver disease

Question 4

Types of arthritis

Answer 4

1. Osteoarthritis- most common form characterised by joint worsening with activity + remodelling of adjacent bones + ROM in joints
   * Bouchards (proximal phalanges) + Heberdens (Distal phalanges) nodes represent osteophyte formation.
2. RA- Autoimmune disease characterised as inflammation of the synovial joints.
   * Pt experience joint pain, swelling, morning stiffness.
   * Other features= muscle wasting, ulnar deviation
3. Psoriatic arthritis- autoimmune disease associated with psoriasis that is characterised by inflammation of the joints

Question 5

Feel- palms up

Answer 5

• Temperature-
• Radial pulses
• Thenar/hypothenar eminence

Question 6

Feel- palms down

Answer 6

• Palpate phalanges
• Palpate metacarpal joints
• Palpate scaphoid

Question 7

Active movement

Answer 7

• Wrist flexion
• Wrist extension
• Ulnar and radial deviation