HAND EXAMINATION

​Examine the hands
-Could be rheumatological, general or neurological
 
Hand Function
     ·      Grip – ‘squeeze my fingers’ = C8/long flexors
·      Pincer grip – adductor pollicis, the one muscle in the thenar eminence that is ulnar innervated. If weak, the thumb flexes.
·      Prayer sign  - positive in RA, Scleroderma/CREST, Diabetes (cheiro-arthropathy), Ulnar Nerve Palsy, T1 palsy – total claw hand, Dupuytren’s, Arthritis of the wrist.
·      Fine movement = pyramidal function – ‘play the piano’

 
Four Signs of Ulnar Nerve Palsy
     ·      Weakness and wasting of the 1st dorsal interosseous muscle
·      Partial claw hand – loose lumbricles
·      Weakness of pincer grip
·      Sensory loss in 5th finger and ulnar half of 4th finger

 
Peripheral Neuropathy – ABCDE
·                Alcohol
·      B12 deficiency
·      CKD
·      Diabetes and drugs (TB drugs/cytotoxics)
·      Every vasculitis
·      (PLUS CANCER (PARANEOPLASTIC) AND LYME DISEASE)