Wrist squeezer skin#

Osler’s nodes: red-purple, slightly raised, tender lumps, often with a pale centre, typically found on the fingers or toes.Janeway lesions are typically associated with infective endocarditis. Janeway lesions: non-tender, haemorrhagic lesions that occur on the thenar and hypothenar eminences of the palms (and soles).Elbows: inspect for evidence of psoriatic plaques or rheumatoid nodules.Thenar/hypothenar wasting: isolated wasting of the thenar eminence is suggestive of median nerve damage (e.g.Dupuytren’s contracture involves thickening of the palmar fascia, resulting in the development of cords of palmar fascia which eventually cause contracture deformities of the fingers and thumb.Scars: inspect for evidence of scars which may indicate previous surgery or trauma (e.g.clawed hand secondary to Dupuytren’s contracture). Hand posture: note any evidence of abnormal hand posture (e.g.With the patient’s palms facing up, inspect each hand for signs suggestive of underlying pathology: Nail pitting and onycholysis: associated with psoriasis and psoriatic arthritis.Causes include local trauma, infective endocarditis, sepsis, vasculitis and psoriatic nail disease. Splinter haemorrhages: a longitudinal, red-brown haemorrhage under a nail that looks like a wood splinter.median nerve damage secondary to carpal tunnel syndrome). Muscle wasting: can occur secondary to chronic joint pathology or lower motor neuron lesions (e.g.Patients who have psoriasis are at significantly increased risk of developing psoriatic arthritis. Psoriatic plaques: salmon coloured plaques with a silvery scale.common in patients with active inflammatory arthritis).

Wrist squeezer skin#

Skin thinning or bruising: can be associated with long-term steroid use (e.g.Boutonnières deformity: PIPJ flexion with DIPJ hyperextension associated with rheumatoid arthritis.Z-thumb is associated with rheumatoid arthritis. Z-thumb: hyperextension of the interphalangeal joint, in addition to fixed flexion and subluxation of the metacarpophalangeal joint (MCPJ).Swan neck deformity is typically associated with rheumatoid arthritis. Swan neck deformity: occurs at the distal interphalangeal joint (DIPJ) with clinical features including DIPJ flexion with PIPJ hyperextension.Heberden’s nodes: occur at the distal interphalangeal joints (DIPJ) and are associated with osteoarthritis.Bouchard’s nodes: occur at the proximal interphalangeal joints (PIPJ) and are associated with osteoarthritis.Skin colour: erythema of the soft tissue may indicate cellulitis or joint sepsis.Swelling: note any areas of swelling, by comparing the hands and the wrists.Scars: inspect for evidence of scars which may indicate previous surgery or trauma.Dupuytren’s contracture, ulnar deviation secondary to rheumatoid arthritis). Hand posture: note any abnormalities of hand posture which may indicate underlying pathology (e.g.With the patient’s palms facing down, inspect the dorsum of each hand for signs suggestive of underlying pathology: analgesia).Ĭlose inspection of the hand Dorsal aspect of the hand Prescriptions: prescribing charts or personal prescriptions can provide useful information about the patient’s recent medications (e.g.Aids and adaptations: splints are often used to manage hand and wrist pathology.Look for objects or equipment on or around the patient that may provide useful insights into their medical history and current clinical status: Wasting of muscles: suggestive of disuse atrophy secondary to joint pathology or a lower motor neuron lesion.Scars: may provide clues regarding previous upper limb surgery.Perform a brief general inspection of the patient, looking for signs suggestive of underlying pathology: You might also be interested in our OSCE Flashcard Collection which contains over 2000 flashcards that cover clinical examination, procedures, communication skills and data interpretation.