Hands

KEY During the examination, expose the arm to above the elbow and, if available, place a pillow on the patient’s lap or desk to make the examination more comfortable. You should comment on anything obvious at the start of your examination, for example if you have been presented with a case of rheumatoid arthritis you could say ‘There is a an obvious bilateral, symmetrical deforming arthropathy’. Look carefully for signs of psoriasis, in case you have been presented with a case of psoriatic arthropathy. To assess the neurology you need only check for light touch in the distribution of the median, ulnar and radial nerves; and assess grip and opposition strength and the power of thumb abduction and finger adduction. If, however, you suspect carpal tunnel syndrome, you will additionally need to perform Tinnels and Phalens tests.