Exam - Hands

From CambridgeNotes

Preparation and planning

  • Expose upper limbs to above elbows
  • Ask patient to bend elbows and look at extensor surface
  • Rest hands on pillows, palm downwards

Look: first dorsum then palmar surface

  • Skin: rash e.g. psoriasis, vasculitis, nodules, tophi, white fingers, sclerodactyly, palmar erythema
  • Nails: pitting (psoriasis), onycholysis (psoriosis or thyrotoxicosis), splinter haemorrhages (vasculitis or subacute bacterial endocarditis), or clubbing (pulmonary fibrosis)
  • Joints: wrist (subluxation and radial deviation), MCP joints (swelling, subluxation and ulnar deviation), IP joints (swelling PIP not DIP in rheumatoid arthritis, Swan neck or Boutoniere of fingers, Z deformity of thumb, Heberden’s and/or Bouchard’s nodes in osteoarthritis)
  • Muscle wasting: thenar (carpal tunnel syndrome), hypothenar (ulnar)

Feel: is arthritis active?

  • Warmth: wrists and MCPs (back of hand)
  • Tenderness: palpate dorsal wrist joint line, depress distal ulna, MCP squeeze, bimanual palpation of IP

Move

  • Make fist and bury fingers, turn clenched fist over, extend little finger alone then extend all fingers
  • Place palms together and bend wrist back; hands back-to-back and bend wrists forward

Function

  • Hook and power grip
  • Pincer and key grip

Neurology and Vascular:

  • Sensation; thumb abduction, finger extension, and finger abduction and adduction; feel arteries

References

  1. ER Web
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