MSK Hand examination

Question 1

What is the first step of the examination?

Answer 1

Introduce self
Confirm patient’s name and DOB
Explain procedure and gain consent

Question 2

What do you do after the introduction?

Answer 2

General inspection -
Look around bed for prescriptions, splints

Question 3

What do you do after inspecting the patient’s area?

Answer 3

Closer inspection of the hands -dorsal surface
-nails
-palmar surface
-elbows

Question 4

What are you looking for on the dorsal aspect on the hand inspection?

Answer 4

Scars
Swelling
Skin colour

Osteoarthritis
-Heberden’s Nodes ( DIPJ)
-Bouchard’s Nodes (PIPJ)

Rheumatoid Arthritis
-Swan neck deformity
-Boutonnières deformity
-Z-thumb

Psoriatic Arthritis
-Psoriatic plaques
-Nail pitting and onycholysis

Steroid use
-Skin thinning or bruising

LMN injury
-Muscle wasting

Splinter haemorrhages ( Local trauma, Sepsis , IE, Vasculitis, Psoriatic nail disease)

Question 5

What are you looking for on the palmar inspection of the hand?

Answer 5

Swelling
Dupuytren’s Contracture
Scars ( Carpal Tunnel surgery)
Thenar/hypothenar wasting (Median/Ulnar nerve damage)
Janeway lesions
Osler’s Nodes

Question 6

What are you looking for on the elbows?

Answer 6

Rheumatoid nodules
Psoriatic plaques

Question 7

What do you do after inspecting the hands?

Answer 7

Assess and compare temperature

Question 8

What do you do after assessing the temeprature?

Answer 8

Palpate the radial pulse
Palpate the medial pulse

Question 9

What do you do after palpating the pulses?

Answer 9

Assess thenar and hypothenar muscle bulk