Hand Examination
W.I.P.E.E
- Sitting
- Exposure = hands
1. Look
- Nails = pitting, onycholysis (white nail, lifts up)
- Skin = thin/bruised, rashes, psoriatic plaque, tight/shiny
- Wrist = prominent ulnar styloid, swelling, erythema
- Palms = erythema, muscle bulk of hypo/thenar muscles
- Scars = carpal tunnel release
- Elbows = rheumatoid nodules (squishy lumps under skin)
- Ears and scalp = gouty tophi/psoriasis
Are the findings symmetrical? Any particular joint affected?
2. Feel
- Palms = thenar and hypothenar eminence
- Sensation = ulnar, median, radial sensation
- Temperature change = Raynaud’s syndrome
- Palpate every finger joint – any synovitis
- Palpate wrist and elbow?
3. Movements
- Make a fist
- Straighten fingers
- (30secs) Prayer test – test for flexion deformities
- (30secs) Phalen’s test – backs of hands together like upside-down prayer – test for carpal tunnel syndrome
- Median nerve function = abduct thumb
- Ulnar nerve function = spread fingers
4. Function
- Assess grip strength in fist
- Ask patient to touch every finger to thumb
- Ask patient to write name/do button/pick up small object
W.I.P.E.E
- Sitting
- Exposure = hands
1. Look
- Nails = pitting, onycholysis (white nail, lifts up)
- Skin = thin/bruised, rashes, psoriatic plaque, tight/shiny
- Wrist = prominent ulnar styloid, swelling, erythema
- Palms = erythema, muscle bulk of hypo/thenar muscles
- Scars = carpal tunnel release
- Elbows = rheumatoid nodules (squishy lumps under skin)
- Ears and scalp = gouty tophi/psoriasis
Are the findings symmetrical? Any particular joint affected?
2. Feel
- Palms = thenar and hypothenar eminence
- Sensation = ulnar, median, radial sensation
- Temperature change = Raynaud’s syndrome
- Palpate every finger joint – any synovitis
- Palpate wrist and elbow?
3. Movements
- Make a fist
- Straighten fingers
- (30secs) Prayer test – test for flexion deformities
- (30secs) Phalen’s test – backs of hands together like upside-down prayer – test for carpal tunnel syndrome
- Median nerve function = abduct thumb
- Ulnar nerve function = spread fingers
4. Function
- Assess grip strength in fist
- Ask patient to touch every finger to thumb
- Ask patient to write name/do button/pick up small object
