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Hand Examination (Deformities (RA ((Swan neck, Z-thumb, Ulnar deviation @…
Hand Examination
Deformities
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Nails
- Onycholysis
- Pitting
- Subungual hyperkeratosis
Extras
Elbows: rheumatoid nodules, psoriatic plaques
Scalp and behind ears: psoriatic plaques
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Set-Up
- Expose pts. arms up to elbow
- Lay hands on a pillow
Function
- Fasten and unfasten button.
- Pick up coin from flat surface
- Write name
Autonomous Sensory Areas
- Median: pulps of index and middle fingers
- Ulnar: pulp of little finger
- Radial: 1st dorsal web space
Autonomous Motor Supply
- Median: abductor pollicis brevis
- Ulnar: 1st dorsal interosseous
- Radial: MCP extension
Dupuytren’s Contracture
Examination
Differential
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Ulnar nerve palsy: ↓ sensation, +ve Froment’s sign
Look
- Often bilateral and symmetrical
- Tethering or pitting of palmar skin
- Visible tendon cords
- Surgical scars: Z plasties
- Fixed flexion of MCP and PIP joints
Usually little and ring fingers
- Garrods Pads
Thickening of dorsal skin over PIPJ
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Carpal Tunnel Syndrome
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Viva
Hx
Symptoms
Tingling / pain in thumb, index and middle fingers
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Causes: I WRIST
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Water: pregnancy, hypothyroidism
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Soft tissue swelling: lipomas, acromegaly, amyloidosis
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Rheumatoid Hands
Examination
Look
Skin: joint erythema, palmar erythema
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Muscle wasting: interossei, thenar eminence
Deformity
- Ulnar deviation @ the MCPs
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Function
Precision: unbutton shirt, pick up coin from table
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Walking aids, splints, wheelchair
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Presentation
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Signs of cause
- Rheumatoid nodules
- Psoriatic plaques
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Viva
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Ix
Bloods
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Immune: RF, anti-CCP, ANA, HLA-DR3/4
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Mx
MDT
GP, physio, OT, rheumatologist, orthopod
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Medical
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Steroids: IM, PO or intra-articular
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Other: CV risk, prevention of PUD and osteoporosis
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OA Hands
Examination
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Completion
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Hips, lumbar spine, knees
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Radial Nerve Palsy
Examination
Look
Wrist drop: holds hands out in front, palms down
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Viva
Causes
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Low → finger drop
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Local wounds, # or dislocation
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Trigger Finger
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Viva
Pathology
Tendon nodule which catches on proximal side of
tendon sheath → triggering on forced extension.
Often FDS tendon
Causes
Idiopathic
Trauma
Activities requiring repetitive forceful flexion
e.g. use of heavy shears
2O to RA
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