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
- 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.
- Bickley L. Bate’s Guide to Physical Examination and History Taking. 10th ed. New York: Lippincott Williams & Wilkins; 2009.
- Filate W, Leung R, Ng D, Sinyor M, eds. Essentials of Clinical Examination Handbook. 5th ed. Toronto, ON. University of Toronto, 2005.