You will be asked to examine the hand
- Things to comment on inspection
- Squaring and shouldering of thumb CMCJ with hyperextended MCPJ and adducted thumb MC
- Shoulder of CMCJ
- Wasting of thenar muscles - can be due to disuse atrophy of thumb
- Features of concomittant Carpal tunnel
- CTS scar
- thenar wasting
- Other OA features of hand - heberden, Bouchard notes
- Specific Exam
- Palpate DIPJ ➔ MCPJ ➔ CMCJ
- Assess for hyperextension at MCPJ - check correctibility and angle with goniometer (cut off 30 °)
- Screen for median nerve
- Kapandji score
- Offer grind test
- Check FCR tendon - for LRTI
- Offer to rule out other causes of radial sided pain
Look closely for nail deformity, herbeden or Bouchard nodes of the thumb