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Hand & Wrist Exam
Hand & Wrist Exam
Examination of the hands and wrists is performed primarily to identify arthropathy or arthritis affecting these joints, with particular attention to the pattern of joint involvement and other systemic signs.

Rheumatoid Arthritis



    • Signs of Rheumatoid Arthritis

    • General Signs

    • Symmetrical arthropathy with sparing of DIP joints
    • Prominence of the ulnar styloid
    • Radial deviation of the wrist
    • Ulnar (medial) deviation of the MCP joints
    • Volar (palmar) subluxation of the MCP joints
    • Swan neck deformity: hyperextension at the PIP joint with flexion at the MCP and DIP joints
    • Boutonniere deformity: flexion at the PIP joints with hyperextension at the MCP and DIP joints
    • Z-thumb deformity: flexion at the IP joint of the thumb with hyperextension at the MCP joint
    • Signs of Complications

    • Evidence of compressive neuropathy - e.g. signs of carpal tunnel syndrome
    • Evidence of vasculitis - palpable purpura
    • Evidence of interstitial lung disease - fine fibrotic crepitations
    • Splenomegaly (Felty’s syndrome)
    • Signs of Severity

    • Evidence of active synovitis
    • Severe deformity
    • Rheumatoid nodules (indicate seropositive disease)
    • X-Ray Findings in Rheumatoid Arthritis

    • Reduced joint space - generally symmetric
    • Articular surface erosions: discontinuities in the bone plate
    • Periarticular osteopaenia - hypodensity of bone surrounding the joint
    • Soft tissue swelling


    • Complications of Rheumatoid Arthritis

    • Ocular - sicca symptoms, scleritis, episcleritis, scleromalacia, scleromalacia perforans
    • Vasculitis - palpable purpura, distal gangrene, mononeuritis multiplex
    • Neurologic - compressive neuropathies (e.g. carpal tunnel syndrome)
    • Pulmonary - interstitial lung disease, pleural effusions, lung nodules
    • Felty’s syndrome (arthritis, splenomegaly and neutropaenia)
Last updated on July 7th, 2019


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