127 Rheumatoid hands
Salient features
Examination
• Comment on deformities (Fig. 127.1) such as the following:
• Comment on the following signs:
• Test grip and pincer movements. Quickly test for abductor pollicis brevis and interossei, and pinprick sensation over index and little fingers. The median nerve may be involved if there is associated carpal tunnel syndrome.
• Examine the elbow for rheumatoid nodules.
• Ask the patient to perform simple tasks involving hand function, such as unbuttoning clothes or writing.
• Tell the examiner that you would like to examine other joints.
• Highlight the following points:
Questions
What is the significance of nodules in rheumatoid arthritis?
The presence of nodules indicates seropositive and more aggressive arthritis (Fig. 127.2).
Where are nodules found?
Flexor and extensor tendons of the hand, sacrum, Achilles tendon, sclera, lungs and myocardium.