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Hand & Wrist Exam
 
 

Hand & Wrist Deformities

 
 
 
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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.
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