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 – 
    • Check Key  grip – power 
    • Powr grip – by asking to crush my fingers –  ( Metacarpophalangial joints, tendons and nerves – together – by looking at the graspign power –  – by squuex my fingers  ) 
    • worship position 
    • unbutton the shirt 
Finally – 
Complete with rhumatoid nodules and psoriasis – on extensor surfaces of forarms – 
 
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