ABSTRACT
Pathology of the hand or wrist can have a signicant eect on activities of daily living. Enquire about specic loss of function.
Localize symptoms to the anatomical area. Establish the duration of symptoms and any precipitating factors. Ask about: ●● Pain ●● Stiness ●● Swelling ●● Deformity
EXAMINATION
Look ●● Resting posture of the hand and wrist ●● Scarring or discoloration ●● Lumps or swellings (Table 6.1)
Rheumatoid arthritis Swan neck deformity, Boutonnière deformity, ulnar deviation of ngers, z-shaped thumb, radial deviation of the wrist, knuckle/wrist subluxation, rheumatoid nodules, swollen joints
Osteoarthritis Bouchard’s nodes, Heberden’s nodes, squaring of the rst carpometacarpal joint
Dupuytren’s contracture Fixed exion of one or more ngers Peripheral nerve injuries Abnormal hand positions, muscle wasting
(especially thenar and hypothenar muscles) Gout Gouty tophi Ganglia Swellings Psoriasis Plaques, nail pitting, onycholysis Connective tissue disease Splinter haemorrhages in the nails
Feel ●● Temperature ●● Any lumps should be examined for consistency and any attachment to
overlying skin or underlying bone or tendon. ●● Localize tenderness (Table 6.2).
