Login or Register to unlock everything MedSchool has to offer!
 
 
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

 
 

Overview

    • 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

    • 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
 
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------
 

Read More...

 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.
Feedback