Sunday, 1 April 2018

[Rheumatology] Physical examination

When investigating patients with possible connective tissue disease, it is important to check the hands thoroughly.

Inspection  

  • Amputations
  • Scars 
  • Deformity
  • Nodules
    • Bouchard's nodes (proximal interphalangeal joints)
    • Heberden's nodes (distal interphalangeal joints) 
    • Rheumatoid nodules
  • Gottron's papules
  • Calcium deposits
  • Sclerodactyly
  • Splinter haemorrhages
  • Nail fold infarcts 
  • Ulceration
  • Erythema 
  • Wasting of the pulp of the fingers

 

Palpation 

  • Heat 
  • Swelling
  • Tenderness 
  • Palpable deformities 

Movement  

  • Finger flexion
  • Finger extension
  • Finger abduction
  • Finger adduction
  • Wrist extension (prayer position)
  • Wrist flexion (reverse prayer position)
  • Wrist adduction
  • Wrist abduction
  • Pronation
  • Supination 


Specific function

  • Coin pickup
  • Writing 
  • Grip strength

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