You will be asked to examine the hand
- [INSPECTION]
- "multiple deformities affecting multiple joints"
- "Pattern suggesting symmetrical arthropathy consistent with an inflammatory arthritis of which Rheumatoid is most common"
- Deformities from proximal to distal:
- Ulna caput = volar subluxation of the carpus rather than a dorsal subluxation of ulna
- Radial deviation at wrist
- Ulnar deviation at MCPJ, possible VOLAR subluxations at MCPJ
- RA thumb
- Boutonniere
- Swan neck deformities
- Nodules at elbow
- Scars - for CTS, tendon transfers
- Trigger thumb
- Carpal tunnel features
- Check palmar and dorsiflexion at wrist
- "No signs of psoriatic arthritis"
- No pitting of nails
- No psoriatic plaques
- [Post grad] Specific Assessments - assess for these and examine further if present - FPL, EDC tendons, deformities (4), function
- TEST for FPL rupture - mannerfelt syndrome
- 1. Need TRO AIN palsy - check FDP of index finger
- 2. Check Tenodesis effect of EPI
- 3. Assess joint integrity - IPJ and MCPJ
- 4. Check BR for transfer
- Examine the dropped finger (Vaughn Jackson)
- 1. Tenodesis effect
- 2. Passive hold (sagittal band)
- 3. If many fingers - TRO PIN palsy. Check EPL, wrist drop
- 4. Evaluate joint ROM for readiness for transfer
- Proceed to check for EIP tendon for transfer
- Examine the Boutonniere - check if correctible and report Nalebuff
- 1/2 = correctible 15 ° vs 30 ° extensor lag
- Fixed = type 3
- Examine the Swan neck - check if correctible and report Nalabuff
- 1/2 = correctible with intrinsic tightness
- 3/4 = fixed (+/- OA changes)
- Examine the ulna caput - piano key sign
- Screen for median nerve palsy on top of screening
- Tinel, Durkan, phalen
- Check Hand function set piece
- Coin, Key, Pen and Forearm - 5 things
- Chuck Grip - pick up pen with 3 fingers
- Dexterity - pick up coin
- Key pinch - key grip and try to twist it out
- Pen/ End grip - writing
- Grasp - grab forearm
- Coin - chuck grip with 3 fingers, dexterity, side grip with key, pen grip, grasp forearm
- Complete examination
- Elbows for rheumatoid nodules
- Listen to lungs for fibrosis
- C-spine for RA spine
- Eye for uveitis
