Rheumatoid Hand

Question 1

Steps in examination of Rheumatoid hand

Answer 1

1. Look - Deformity - 
•  Ulnar deviation 
•  Swan neck deformity
•  Boutonniere deformity 
•  Z deformity of thumb 
•  Volar sublaxation
•  Inflammation at proximal I/P & MP joints
•  Wasting of small muscles of hand
•  Vasculitic rash

2. Feel - Ask for pain first
   • Sublaxation of joints–> excess mobility
   • Fixed deformity of joint
   • Palpate the forearm up to elbow for rheumatoid nodule
3. Test for hand functions
   • Ask - writing, self care e.g. feeding, dressing etc
   • Test - hand grip, thumb opposition