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Hand & Wrist Exam

Skin Examination


Psoriatic Plaques

    • Look For

    • Raised erythematous patches, particularly affecting the extensor surfaces of joints, scalp, periumbilicus, lower back and skin folds
    • Significance

    • In a patient with a symmetric polyarthritis, the presence of psoriatic plaques is pathognomonic for psoriatic arthritis, and are very useful in distinguishing this from rheumatoid arthritis - the other major differential.

Gottron’s Papules

    • Look For

    • Thickened erythematous lesions over the dorsal aspects of the metacarpophalangeal and interphalangeal joints.
    • Significance

    • Gottron’s papules are pathognomonic for dermatomyositis.


    • Look For

    • Thickening of the skin of the fingers and / or toes.
    • Causes of Sclerodactyly

    • Scleroderma
    • Mixed connective tissue disease

Raynaud’s Phenomenon

  • An episode of Raynaud’s phenomenon manifests as subsequent white, blue and then red discolouration of the fingers (or toes) due to ischaemia, cyanosis and then hyperaemia. These may occur in response to cold or emotional stress.
    • Look For

    • Areas of white, blue or red change in the hands.
    • Causes of Raynaud’s Phenomenon

    • Raynaud’s disease (primary / idiopathic)
    • Connective tissue disease - scleroderma, systemic lupus erythematosus, rheumatoid arthritis, mixed connective tissue disease, inflammatory myopathies
    • Arterial occlusion - acute ischaemia, peripheral vascular disease, thromboangiitis obliterans, thoracic outlet obstruction
    • Haematologic - cold agglutinin disease, paraproteinaemia, cryoglobulinaemia, Waldenstrom’s
    • Trauma - vibration injury, cold injury
    • Drugs - beta blockers, ergotamine, chemotherapy
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