Hand & Wrist Exam
 

Hand & Wrist Deformities

 
 
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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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Backhouse KM. Innervation of the Hand. Hand. 1975. 7:107.
De Souza RM, Choi D. Peripheral Nerve Lesions. Surgery. 2012; 30(3): 149-154.
Dinsdale G, Herrick AL. Vascular diagnostics for Raynaud’s phenomenon. J Vasc Diagn. 2014;2:127-39.
 Hainer BL, Matheson E, Travis Wilkes R. Diagnosis, treatment, and prevention of gout. American family physician. 2014 Dec 15;90(12). Hughes M, Herrick AL. Assessment and management of Raynaud's phenomenon. Prescriber. 2017 Jul;28(7):11-6. Lowe G, Tait C. Limb Pain and Swelling. Medicine. 2009 Feb; 37(2): 96-99. Ma L, Cranney A, Holroyd-Leduc JM. Acute monoarthritis: What is the cause of my patient's painful swollen joint?. Cmaj. 2009 Jan 6;180(1):59-65. Palmer KT. Pain in the Forearm, Wrist and Hand. Best Practice and Research Clinical Rheumatology. 2003; 17(1): 113-135. Reddy RS. Compson J. Examination of the Wrist - Surface Anatomy of the Carpal Bones. Current Orthopaedics. 2005; 19; 171-179. Ricceri F, Prignano F. Gottron papules: a pathognomonic sign of dermatomyositis. Cmaj. 2013 Feb 5;185(2):148-. Rothschild BM, Pingitore C, Eaton M. Dactylitis: implications for clinical practice. InSeminars in arthritis and rheumatism 1998 Aug 1 (Vol. 28, No. 1, pp. 41-47). WB Saunders. Siva CH, Velazquez CE, Mody A, Brasington RI. Diagnosing acute monoarthritis in adults: a practical approach for the family physician. American family physician. 2003 Jul 1;68(1):83-92. Skirven T. Clinical Examination of the Wrist. Journal of Hand Therapy. 1996 Apr-Jun; 9(2): 96-107. Thaper A, Zhang W, Wright G, Doherty M. Relationship between Heberden’s nodes and underlying radiographic changes of osteoarthritis. Annals of the rheumatic diseases. 2005 Aug 1;64(8):1214-6. Turesson C, O’fallon WM, Crowson CS, Gabriel SE, Matteson EL. Extra-articular disease manifestations in rheumatoid arthritis: incidence trends and risk factors over 46 years. Annals of the rheumatic diseases. 2003 Aug 1;62(8):722-7. Young D, Papp S, Giachino A. Physical Examination of the Wrist. Orthopedic Clinics of North America. 2007; 38(2): 149-65.
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