Expansion
Look, feel, move and function, with characteristic deformity patterns
Expansion
| Feature | Rheumatoid | Osteoarthritis | Psoriatic |
|---|---|---|---|
| Joints | MCP and PIP, spares DIP | DIP and thumb base | Any, including DIP |
| Distribution | Symmetrical | Asymmetrical | Asymmetrical, dactylitis |
| Nodes | Rheumatoid nodules | Heberden (DIP) and Bouchard (PIP) | |
| Deformity | Ulnar deviation, swan neck, boutonniere, Z thumb | Squaring of the thumb base | Arthritis mutilans |
| Skin and nails | Nodules, vasculitis | Psoriatic plaques, nail pitting, onycholysis | |
| Stiffness | Early morning, over an hour | Brief, after activity | Inflammatory pattern |
Sequence
- Look: dorsum then palm, with the hands on a pillow. Skin, nails, muscle wasting, deformity, swelling
- Feel: temperature, MCP squeeze, individual joints, nodules, palmar thickening, pulses
- Move: active then passive; make a fist, precision pinch, wrist movements
- Function: grip strength, buttons, writing, holding a cup
- Special tests: Tinel and Phalen for carpal tunnel, Finkelstein for de Quervain
Complete by examining the elbows for nodules and psoriatic plaques, and the rest of the joints.