A

• Anatomical Snuffbox

  • Definition: Triangular depression on the lateral wrist visible when the thumb is extended.

  • Clinical significance: Tenderness here suggests scaphoid fracture or De Quervain’s tenosynovitis.

• Arthritis

  • Definition: Inflammation of one or more joints causing pain, swelling, stiffness.

  • Types relevant to the hand: Rheumatoid arthritis (RA), osteoarthritis (OA), psoriatic arthritis.

B

• Boutonnière Deformity

  • Definition: Flexion of the proximal interphalangeal (PIP) joint and hyperextension of the distal interphalangeal (DIP) joint.

  • Cause: Rupture of the central slip of the extensor tendon, commonly in RA or trauma.

• Bouchard’s Nodes

  • Definition: Bony enlargements at the PIP joints.

  • Associated with: Osteoarthritis.

• Bilateral Symmetry

  • Importance: Symmetrical joint involvement favors inflammatory arthritis like RA over degenerative causes.

C

• Carpal Tunnel Syndrome (CTS)

  • Definition: Median nerve compression at the wrist causing pain, numbness, and tingling in the thumb, index, middle, and radial half of the ring finger.

  • Examination signs: Positive Tinel’s sign and Phalen’s test.

• Crepitus

  • Definition: Grating or crackling sensation felt on joint movement, indicating roughened articular surfaces (e.g., in OA).

D

• DIP Joint

  • Definition: Distal interphalangeal joint (closest to the fingertip).

  • Commonly involved in: Osteoarthritis and psoriatic arthritis.

• De Quervain’s Tenosynovitis

  • Definition: Inflammation of the tendons on the radial side of the wrist.

  • Test: Positive Finkelstein’s test (pain on ulnar deviation of the wrist with thumb flexed).

E

• Erosion

  • Definition: Bone loss seen on X-ray at joint margins, characteristic of inflammatory arthritis like RA.

• Effusion

  • Definition: Accumulation of excess synovial fluid within a joint.

  • Detectable by: Swelling, palpable fluid wave, sometimes fluctuation.

F

• Flexion Contracture

  • Definition: Inability to fully extend a finger due to shortening of tendons or ligaments.

  • Common cause: Dupuytren’s contracture.

• Finkelstein’s Test

  • Purpose: Diagnose De Quervain’s tenosynovitis.

  • Procedure: Patient grasps thumb, ulnar deviation of wrist causes pain if positive.

G

• Ganglion Cyst

  • Definition: Noncancerous fluid-filled cyst near joints or tendons, commonly on the dorsum of the wrist.

  • Clinical note: May fluctuate in size; usually painless but can cause discomfort.

H

• Heberden’s Nodes

  • Definition: Bony enlargements at the DIP joints.

  • Significance: Classic feature of osteoarthritis.

• Hypothenar Eminence

  • Definition: Muscular bulge on the ulnar side of the palm.

  • Atrophy here can indicate ulnar nerve pathology.

I

• Interphalangeal Joints

  • Definition: Joints between the phalanges; include PIP and DIP joints.

• Inflammation Signs

  • Include: Redness, warmth, swelling, tenderness, and loss of function.

J

• Joint Line Tenderness

  • Definition: Pain on palpation along the joint margins.

  • Indicates: Synovitis, arthritis, or joint pathology.

L

• Lumbrical Muscles

  • Function: Flex the metacarpophalangeal (MCP) joints and extend the interphalangeal joints.

  • Weakness may cause deformities in rheumatoid arthritis.

M

• Metacarpophalangeal (MCP) Joint

  • Definition: Joint between the metacarpal bones and proximal phalanges.

  • Commonly affected in rheumatoid arthritis.

• Muscle Wasting

  • Significance: Suggests chronic nerve compression or disuse atrophy.

N

• Nodules

  • Rheumatoid Nodules: Firm, non-tender subcutaneous lumps seen in RA, often over extensor surfaces.

O

• Osteoarthritis (OA)

  • Definition: Degenerative joint disease characterized by cartilage loss and bony proliferation.

  • Hand signs: Heberden’s and Bouchard’s nodes, joint stiffness, and crepitus.

P

• Phalen’s Test

  • Purpose: Diagnoses carpal tunnel syndrome.

  • Procedure: Patient flexes wrists maximally and holds position for 60 seconds; tingling/numbness suggests median nerve compression.

• Power Grip

  • Definition: Gripping object with palm and fingers.

  • Assessment: Tests overall hand strength.

• PIP Joint

  • Definition: Proximal interphalangeal joint (middle joint of fingers).

R

• Rheumatoid Arthritis (RA)

  • Features: Symmetrical joint swelling, morning stiffness >1 hour, involvement of MCP and PIP joints.

  • Deformities: Swan-neck, Boutonnière, ulnar deviation.

• Range of Motion (ROM)

  • Assessment: Active and passive joint movements to detect stiffness or contracture.

S

• Swan-neck Deformity

  • Definition: Hyperextension of the PIP joint and flexion of the DIP joint.

  • Causes: Rheumatoid arthritis, trauma.

• Synovitis

  • Definition: Inflammation of the synovial membrane, causing swelling and tenderness.

• Swelling

  • Localized or diffuse, indicates joint or soft tissue pathology.

T

• Trigger Finger (Stenosing Tenosynovitis)

  • Definition: Finger stuck in flexed position that suddenly releases with a snap.

  • Cause: Thickening or inflammation of the flexor tendon sheath.

• Tenderness

  • Assessment: Palpate joint margins, tendon insertions, and soft tissues for pain.

W

• Wrist Drop

  • Definition: Inability to extend the wrist and fingers.

  • Cause: Radial nerve palsy.

Examination Maneuvers & Tests

Clinical Pearls

• Always compare both hands for symmetry of findings.

• Look for subtle deformities and nodules—early RA signs can be missed.

• Assess functional impact on daily activities like buttoning, gripping, and writing.

• Check for sensory changes to evaluate for nerve compression syndromes.

• Remember that morning stiffness >1 hour strongly suggests inflammatory arthritis.