Musculoskeletal - Hands

Question 1

General clinical signs + objects/equipment

Answer 1

Scars, muscle wasting
Aids/adaptations e.g. splints, painkillers/prescriptions

Question 2

Non-finger signs on dorsal aspect of hands

Answer 2

Hand posture (Dupuytren’s, ulnar deviation)
Scars
Swelling
Skin colour (erythema, cyanosis)
Skin thinning/bruising (steroids)
Psoriatic plaques
Muscle wasting

Question 3

Finger + nail signs on dorsal aspect of hands

Answer 3

Bouchard’s nodes - PIP
Heberden’s nodes - DIP
Swan neck deformity - DIP flex, PIP ext
Boutonniere’s deformity - PIP flex, DIP ext
Z-thumb - MCP flex + sublux, IP ext

Splinter haemorrhages
Nail pitting + onycholysis

Question 4

Clinical signs on palmar aspect of hands

Answer 4

Hand posture, scars, swelling
Thenar/hypothenar wasting
Janeway lesions (palms/soles), Osler’s nodes (fingers)
Dupuytren’s contracture (thickening of palmar fascia)

Question 5

Nerve sensation areas

Answer 5

Median nerve = thenar eminence + index finger
Ulnar nerve = hypothenar eminence + little finger
Radial nerve = 1st dorsal webspace

Question 6

Wrist + finger extension nerve?

Answer 6

Radial nerve

Question 7

Index finger abduction nerve?

Answer 7

Ulnar nerve