Hands’ Joints Exam

  • WIPE, blah blah 🙂
  • “Take vital signs”
  • Proper exposure: of both hands
  • Position: both hands on a pillow
  • General inspection of the patient + surroundings

 

  • Look:
    • Nails:
      • Pitting nails
      • Onycholysis
    • Hands\palms:
      • Rash
      • Palmar erythema
      • Scars
      • Thenar\hypothenar muscle wasting
      • Dupuytren’s contracture
    • Joints:
      • Swelling, redness
      • Nodes: Heberden’s (DIP), Bouchard’s (PIP)
    • Deformities: (normal resting position)
      • Ulnar deviation
      • Boutonnière
      • Swan neck
      • Z-deformity of the thumb
      • Mallet finger
    • Elbows:
      • Rheumatoid nodules
      • Psoriatic plaques
      • Gouty tophi
  • Feel: (first ask if they have pain?)
    • Skin: temperature
    • Thenar \ hypo thenar muscles for wasting
    • Tendon thickening
    • Palpate each joint: (bi-manual): for swelling, tenderness
      • Wrists
      • MCP (+squeeze)
      • PIP
      • DIP
    • Anatomical snuff-box
  • Move: passive, active, against resistance
    • Wrists: (extension, flexion,)
    • Thumb: (extension, abduction, adduction, opposition)
    • Fingers: (extension, flexion -> make a fist, abduction, adduction)
  • Function:
    • Power grip
    • Pincer grip
    • Pick up a small object
  • Special tests:
    • Tinel’s sign: (tap over carpal tunnel -> ask pt if they have tingling)
    • Pahlen’s maneuver: flex wrists for 60 secs
  • Neurovascular: (refer to Hand Injury Approach)
    • Assess sensation of radial, median, and ulnar N.
    • Radial pulse 

 


Download the PDF version: here

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