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Hand & Wrist Exam
Hand & Wrist Exam
There are several pathognomonic signs in the hand and wrist that are suggestive of rheumatoid arthritis or osteoarthritis. This page outlines these findings.
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The Patient
Inspection
- Assess the dorsal and palmar aspects of the hands; wrists and elbows
Skin
Rashes, sclerodactyly, Raynaud’s
Swelling
Joint swelling, dactylitis
Muscle Wasting
Thenar / hypothenar eminence
Deformities
Ulnar deviation, boutonniere, swan neck, z-thumb, Heberden’s, Bouchard’s
Nails
Onycholysis, pitting, ridging, splinter haemorrhages
Elbows
Nodules, gouty tophi, psoriasis
Peripheral Nerve Signs
Wrist drop, benediction hand, claw hand
Sensory Examination
Radial, median, ulnar nerves
Palpation
- Important anatomy
Wrist and Ulnar Styloid
Synovitis, effusions, ROM, crepitus
Metacarpophalangeal Joints
Synovitis, effusions, ROM, crepitus, subluxation
Proximal & Distal Interphalangeal Joints
Synovitis, effusions, ROM, crepitus, subluxation
Palms
Flexor tendon crepitus
Tests for Carpal Tunnel Syndrome
If appropriate
Tinel’s sign, Phalen’s test
Movement
- Ask before stressing painful joints
Active → Passive Grip Strength
Pincer Grip
Wrist Flexion
Anterior movement of the wrist
80°Wrist Extension
Radial Nerve
Posterior movement of the wrist
70°Ulnar Deviation of the Wrist
Medial angulation of the wrist
30°Radial Deviation of the Wrist
Lateral angulation of the wrist
20°Flexion of MCP, PIP and DIP joints
Closing the fist
80-100°Extension of MCP, PIP and DIP joints
Opening the hand
0°Finger Abduction
Ulnar nerve
Moving fingers apart in coronal plane
20°Finger Adduction
Bringing fingers together in coronal plane
20°Thumb Flexion
Anteriorly away from the palm
50°Thumb Extension
Posteriorly toward the palm
10°Thumb Abduction
Median Nerve
Laterally away from the hand
70°Thumb Adduction
Medially toward the hand
70°Thumb Opposition
Diagonally across the palm
70°
Functional Tests
- These tests assess the fine motor skills performed by the small muscles in the hands, and are reflective of the patient’s ability to perform tasks such as dressing, writing and cooking
Grip Strength
Ask the patient to make a fist and squeeze fingers
Opening a Jar
E.g. a urine jar
Key and Lock Test
Ask the patient to pick up a key, put it in an imaginary lock and turn it
Buttoning a shirt cuff
Ask the patient to unbutton and rebutton a shirt cuff
Hand & Wrist Deformities
On this page:Ulnar DeviationBoutonniere DeformitySwan Neck DeformityZ-Thumb DeformityHeberden’s NodesBouchard’s Nodes
Overview
- There are several pathognomonic signs in the hand and wrist that are suggestive of rheumatoid arthritis or osteoarthritis. This page outlines these findings.
Ulnar Deviation
Look For
- Ulnar (medial) deviation of the metacarpophalangeal joints.
Significance
- A sign of rheumatoid arthritis.
Boutonniere Deformity
Look For
- Flexion at the proximal interphalangeal joint with hyperextension at the metacarpophalangeal and distal interphalangeal joint
Significance
- A sign of rheumatoid arthritis.
Swan Neck Deformity
Look For
- Hyperextension at the proximal interphalangeal joint joint with flexion at the metacarpophalangeal and distal interphalangeal joint
Significance
- A sign of rheumatoid arthritis.
Z-Thumb Deformity
Look For
- Flexion at the interphalangeal joint at the thumb with hyperextension at the metacarpophalangeal joint
Significance
- A sign of rheumatoid arthritis.
Heberden’s Nodes
Look For
- Firm swellings over the distal interphalangeal joints.
Significance
- A sign of osteoarthritis.
Bouchard’s Nodes
Look For
- Firm swellings over the proximal interphalangeal joints.
Significance
- A sign of osteoarthritis.
Last updated on November 25th, 2019
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