Hand and Wrist Examination

Recognizing the patterns of inflammatory and degenerative hand arthritis.

Video lesson

In the studio

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Key points

RA classically affects MCPs, PIPs and wrists symmetrically with soft, boggy swelling. OA affects DIPs (Heberden’s nodes), PIPs (Bouchard’s nodes) and the thumb base with hard bony swelling. PsA can involve DIPs with nail changes and dactylitis.

Practical approach

Use the squeeze test across MCPs for synovitis. Check grip, Finkelstein test for de Quervain tenosynovitis, and Phalen and Tinel for carpal tunnel.

Pearls

Morning stiffness over 30 minutes and soft swelling point toward inflammation, not OA.

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At a glance