CLINICAL SKILLS UNIT

EDUCATIONAL LOOPS

BY

CHSE

Acknowledgements: All the images have been taken from the following source

Diagnosis in colour

Physical

Signs in

General

MedicineSecond edition

Michael Zatouroff

Mosby-Wolfe

Published 1996

Copyright © Times Mirror International Publishers Ltd.

GCE EXAMINATION OF THE HAND

Inspect

Palpate and Feel

Test for temperature and for moisture

Tenderness

Special tests

Fists, Flairs and Finger Tests

AVOID LISTS WITH THINGS YOU CAN’T EXPLAIN

GCE EXAMINATION OF THE HAND

AVOID LISTS WITH THINGS YOU CAN’T EXPLAIN

DON’T FORGET TO COMPARE THE FINDINGS OF BOTH SIDES

INSPECTION

Size

Symmetry

Deformity

Tradition and culture

Habits or occupation

Disorders and Diseases

Colour

INSPECTION (CAN) BEGINS WITH THE PALM

a) Size

b) Shape

c) Symmetry (left with right and same side)

d) Tradition and culture

e) Habits or occupation

f) Disorders and Diseases

g) Colour (palm or finger pulps)

TURN THE HAND OVER AND YOU CAN INSPECT BOTH THE NAILS AND THE HAND

a) Nails

b) Joints

c) Lost limbs

NAILS AND NAILBEDS

a) Allow fingers to be slighted flexed

b) Observe nail beds

c) Observe any irregularity of nails

Temperature can be felt with back of hand or palm

Calluses can be felt for with palm

Moisture is often detected best with finger pulps (very sensitive)

Once seen never forgotten, but seldom seen!!

Clear deformity (arthritis mutilans caused by Psoriatic arthritis)

MAKE A FIST

FINGER FLAIRING

THIS TEST IS FOR MUSCULAR AND NEUROLOGICAL INTEGRITY

MAKE A FIST

THEN MAKE A FLAIR

THEN DO THE THUMB-FINGER WALKING TEST

SELDOM SEEN TODAY, TABACCO STAINS OF AN ADDICTED SMOKER

Note too, badly kept nails suggesting a patient who does not look after himself or herself.

Leuconychia – commoner than you think,

Cause usually unknown may appear in several different way:

Punctate, striate or even complete. This appearance is not at all like the white nails of hypoalbuminaemia or that caused by a fungal infection

Striate Leuconychia

Punctate Leuconychia

NAIL BED PALLOR - ANAEMIA

There are two hands here one showing nail bed pallor due to anaemia the other for comparison

Leuconychia – (again) Did you see it? And what type?

Make sure that what you see in a hand is agreed with by your observations elsewhere

Although some laughingly say that they can see pallor where ever it shows itself – be reasonable!!

FINGER CLUBBING

WHEN MORE ADVANCED THE FINGER ITSELF DEVELOPES A DRUMSTICK APPEARANCE (BELOW)

The cause is still uncertain but one suggestion is the release of platelet growth factors from platelet precursors trapped in the nail bed vasculature.