Hand RA Exam

Screening of Joints

 

Neck

-  ROM

 

Shoulder

- behind head / to mouth

- to back pocket 

 

Elbows

- flexion / extension elbows 

- pronation / supination with thumb up & elbows by side

 

Wrist

- flexion / extension

 

Hand

- make fist with thumb in and out 

- spread fingers

 

Functional Assessment of Hand

 

Power Grip 

Precision Grip 

Hook Grip 

Lateral Pinch Grip 

Tip Pinch

 

1.  Tip to Tip Pinch Grip

- pick up coin 

 

2. Lateral pinch grip

- turn key

 

3. Precision grip

- write with pen

 

4.  Power Grip

- turn knob 

 

5.  Hook Grip

- hold suitcase / fingers

 

Look at Hands / Place on Pillow

 

Palms up

 

Scars

- CTD / flexor tendon synovectomy

Swelling

- flexor sheath synovium

Thenar & Hypothenar eminences

 

Thumb up

 

Thenar wasting

Swan neck / Boutonniere deformity

 

Rheumatoid thumb Boutonneire

 

Palms down

 

Rheumatoid Hand

 

Wrist 

- synovitis / synovectomy

- wrist fusion

- caput ulna

- radial drift 

 

MCPJ 

- ulna drift / replacement / synovitis

- tendon subluxation

 

Fingers

- Swan neck / Boutonniere deformity

- rheumatoid nodules

 

Rheumatoid Nodules

 

Feel

 

Sensation

- median nerve / CTS

- ulnar nerve

 

Move

 

Extensor tendons

- drop fingers

- DDx - locked trigger, tendon subluxation, joint subluxation, PIN palsy

 

EPL

- ruptures over Listers

- IPJ is extended by intrinsics also

 

Flexor tendons

- rupture IF & thumb (synovitis)

- rupture FPL alone over trapezial ridge (Mannerfelt)

- triggering

 

MCPJs

- ? subluxed

 

Boutonniere deformity

- degree of lag

- passively correctable

- ? arthritic changes

 

Swan neck deformity

- passively correctable

- intrinsic tightness / Bunnell test

- arthritic changes

 

Swan Neck Finger 1Rheumatoid Swan Neck Finger 1

 

Bunnell Test

- test with MCP extended and flexed

- correct ulna deviation

- invalidated by MCPJ dislocation

- with tight interossei will have reduced PIPJ flexion with MCPJ extension