OnExam

Inspection

  • Common deformities to be noted
    • Mallet finger or thumb
    • Swan-neck and Boutonniere deformities (RA)
    • Dupuytren’s contracture (usually 3rd/4th digits)
    • Heberden’s (DIP) and Bouchard’s nodes (PIP) (OA)
    • Radial (OA) or ulnar (RA) deviation
    • Nail pitting (psoriatic arthritis)
    • Inflammation of PIP (RA) and DIP (psoriatic arthritis)

Palpation

  • Note areas of pain, swelling, deformity or crepitus in the following structures:
    • Metacarpals
    • Metacarpophalangeal (MCP) joints
    • Proximal phalanges
    • Proximal interphalangeal (PIP) joints
    • Middle phalanges
    • Distal interphalangeal (DIP) joints
    • Distal phalanges
    • Thenar and hypothenar eminences

Range of Motion

  • Digit II-IV ROM:
    • MCP: 90˚ flexion, 20° extension, 15° abduction (digits II, IV, V away from III), adduction to touch adjacent digit (digits II, IV, V toward III)
    • PIP: 100° flexion, 10° extension
    • DIP: 80° flexion, 10° extension
  • Thumb ROM:
    • MCP: 55° flexion, 5° extension, abduction, adduction, opposition
    • IP: 80° flexion, 20° extension
  • References

    1. Baxter S, ed., McScheffrey G, ed. Toronto Notes: Comprehensive Medical Reference & Review for MCCQE 1 & USMLE 2. 26th ed. Toronto: Toronto Notes for Medical Students Inc; 2010.
    2. Bickley L. Bate’s Guide to Physical Examination and History Taking. 10th ed. New York: Lippincott Williams & Wilkins; 2009.
    3. Filate W, Leung R, Ng D, Sinyor M, eds. Essentials of Clinical Examination Handbook. 5th ed. Toronto, ON. University of Toronto, 2005.