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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