MSK - Hand

Question 1

“What are some signs that you may find on the Dorsal Aspect of the Hand?”

Answer 1

• Scars, Swelling
• Skin Thinning/Bruising = Long Term Steroid Use (Common in pt with active Arthritis)
• Bouchard’s Nodes (PIPJ), Heberden’s Nodes (DIPJ) = Osteoarthritis
• Swan Neck Deformity, Boutonnieres Deformity, Z-Thumb = Rheumatoid Arthritis
• Psoriatic Plaques, Nail Pitting, Onycholysis = Psoriatic Arthritis
• Splinter Haemorrhages = Psoriatic Nail Disease, Local Trauma, Infective Endocarditis, Sepsis, Vasculitis
• Osler’s Nodes, Janeway Lesions = Infective Endocarditis

Question 2

“What are some signs that you may find on the Palmar Aspect of the Hand?”

Answer 2

• Scars, Swelling
• Dupuytren’s Contracture
• Thenar/Hypothenar Wasting - Median Nerve Damage

Question 3

“What are some signs that you may find on the Elbows?”

Answer 3

• Rheumatoid Nodules

- Psoriatic Plaques

Question 4

“Describe the nerve supply to the hand?”

Answer 4

Ulnar Nerve - Dorsal and Palmar -> Pinky + Lateral Half of Ring

Median Nerve - Palmar Thumb, First, Second + Medial Half of Ring. Dorsal Fingertips of those fingers.

Radial Nerve - Dorsal Remains.

Question 5

“Describe the three movements to test nerve function in the Hand Examination?”

Answer 5

• Radial Nerve → Extensors of Wrist and Finger → “Stop Traffic”
• Ulnar Nerve → Index Finger Abductors → “Splay Fingers”
• Medial Nerve → Thumb Abduction → “Thumb to the ceiling”

Question 6

“Describe the movements of the Thumb”

Answer 6

Flexion
Extension
Abduction
Adduction
Opposition 
Reposition