Wasting of the small muscles of the hand

62 Wasting of the small muscles of the hand



Instruction


Examine this patient’s hands.


Ask the patient whether her hands are painful.



Salient features



History




• Rheumatoid arthritis


• Painful neck movements (cervical spondylosis)


• Fasciculations, weakness (motor neuron disease)


• Associated sensory loss (syringomyelia)


• Family history (Charcot–Marie–Tooth disease)


• Ascending muscle weakness (Guillain–Barré syndrome)


• Trauma to upper limbs (bilateral median and ulnar nerve lesions).



Examination




• Wasting of thenar and hypothenar eminences and dorsal interossei.


Proceed as follows:



• Look for deformity and swelling


• Look for fasciculations


• Check sensation over the hand, especially index and little fingers


• Test grip and pincer movements


• Test for median and ulnar nerve compression


• Ask the patient to unbutton clothes or to write


• Palpate for cervical ribs and compare radial pulses


• Look for Horner syndrome


• Examine the neck and test neck movements.

Related posts:

  1. Permanent cardiac pacemaker/implantable cardioverter-defibrillator
  2. Cauda equina syndrome
  3. Dermatomyositis
  4. Dystrophia myotonica

Stay updated, free articles. Join our Telegram channel
Tags:
Dec 4, 2016 | Posted by in GENERAL & FAMILY MEDICINE | Comments Off on Wasting of the small muscles of the hand

Full access? Get Clinical Tree
Get Clinical Tree app for offline access