ISCES - MSK Flashcards
What are you looking for in a rheumatological hand exam?
ensure finger joints, wrist, elbow examined
Look:
Nail changes - pitting, onycholysis (PA)
Swan neck/Boutonnieres deformity (RA)
ulnar deviation at MCP joints (RA)
Z shaped deformity to the thumb (RA)
Heberdens/bouchards nodes (OA)
squaring at base of thumb (OA)
Skin plaques (PA)
Rheumatoid nodules
Thenar eminence for muscle wasting (carpal tunnel syndrome linked to RA)
Feel:
Swelling (**boggy feeling tends to be more synovitis)
Pain (each joint in turn)
Move:
finger flexion, extension, abduction, adduction
wrist flexion & extension
Special tests:
Phalen’s & tinel’s test
Ask them to write to assess functional status = palmar grasp
Ask them to pick up someone small to assess functional status = pincer grip
