Look at patient – general inspeciton –
patient does not seem to be in pain – not dyspnic-
no sings of eye diestes – no red eye
no obvious joint deformtity that i can see in other ojints
GET THE PATIENT TO SIT IN THE EDGE of the bed and KEEP THE HANDS ON A PILLOW
Expose from the elbow –
Inspection –
Swelling, scars, Skin changes ( thinning, palmar erythema ) , wasting of small muslces ( Hollow ridges ) , deformity of joints, – and inspect the nails – ( see fro aymetry )
in both sides – first the dorsal aspect and then the ventral aspect
deformity of fingers –
eg – harbedan nodules and bouchards noduiles in OA
Z deformity of thumb and swan neck deformity in RA
Ulnar deviation
no skin tethering – noted in scleroderma
feel all joints of the hand – startgin from wrist – to thumb, M-P joints distal and proximal IP joint s-
examine in both hands
skeez the wrist and fingers
look for – synovitis/ swelling, warmath, and tenderess
now turn the hands over and examine for palmar serfaces –
check for thickening of palmar tendons by feeling for rough tendons by asking to flex the fingers while holding. feelign the palm –
MOVE –
Then check active movements of hand –
wrist flexion – and extention – against presure –
thumb movemetns –
extention – RADIAL ,
abduction ( towrds the roof ) – MEDIAN _ ,
adduction , FLexion –
Opposition – Median ( with small finger ) and with index finger median nerve AIN )
Check Flexor profundus
Check superficialis
Check for individual nerves –
Motor –
Ulnar nerve – by looking at power in holding a paper inbetween the small and ring finger – and thumb and index finger ( froment’s sign )
Median – by asking to make OK sign and thumb and small finger opponance – try to break it
Radial nerve – Thumb extention –
Sensory –
Check for peripheral neuropathy at the same time –
Check for CTS signs –
Now check for Phenal test ( for 20 sec ) and tinnal test –
Finkalstine
Check for joint funtion – – FUNCTIONAL test –
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Check Key grip – power
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Powr grip – by asking to crush my fingers – ( Metacarpophalangial joints, tendons and nerves – together – by looking at the graspign power – – by squuex my fingers )
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worship position
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unbutton the shirt
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Finally –
Complete with rhumatoid nodules and psoriasis – on extensor surfaces of forarms –