Compare the temperature between the forearm, wrist, and MCP joints on the dorsal aspect of the hands with the back of your hand. Compare both hands.

Inflammation in a joint will cause the overlying skin to be noticeably warmer than the forearm.

Put your thumbs on the dorsum of the wrist and your index fingers beneath it. Palpate the groove of the wrist joint and note swelling, bogginess, or tenderness.

Swelling / tenderness bilaterally for several weeks suggests rheumatoid arthritis.

Compress the MCP joints by squeezing the patient's hand between your thumb and index finger.Using both hands, examine each MCP joint by putting your thumbs above and index fingers below the joint. Feel distal to and on each side of the knuckle on the dorsal side and your index fingers to feel the head of the MCP on the palm. Feel for fluid / bogginess , swelling, and watch the patients face to note any tenderness.

Left: Position your thumbs on the laterodorsal aspect of the MCP joint. Right: Position your index fingers on the palmar aspect of the joint.

The MCP joints are often boggy and tender in rheumatoid arthritis.

Use the 'interlocking Cs' method to examine the PIP and DIP joints to detect tenderness, bogginess, swelling, or boney enlargement.

Use your index finger and thumb to make 'Cs' with each hand. Each 'C' should either examine the palmar - dorsal aspect of each joint, or medial - lateral. Left: PIP joint examination. Right: DIP joint examination.

Boggy PIP swelling is seen in RA. Hard dorsal nodules on the PIP and DIP joints (Bouchard's and Heberden's nodes) are common in OA.

Compare thenar and hypothenar muscle groups in both hands by feeling them with your thumbs while holding the patient's hand. Feel in the palms for any thickening of the skin or the flexor tendon sheaths.

The hand is innervated by three nerves (ulnar, median and radial).

• The ulnar nerve enters the hand at the wrist with the ulnar artery through Guyon’s canal and is responsible for sensation over the volar and dorsal ulnar one a half fingers and along these lines into the palm and dorsum of the hand.
• The median nerve enters the hand at the wrist via the carpal tunnel along with nine flexor tendons and is responsible for sensation over the volar aspect of the radial three and a half fingers and palm as well as the distal dorsal aspect of the same fingers.
• The radial nerve enters the hand dorsally and provides sensation over the proximal, dorsal aspect of the radial three and a half fingers as well as that area of the dorsum of the hand that extends along these lines.

Sensory innervation of the hand; ©qscalpel (illustration by S. Moodie)

This module does not aim to teach examination for compression neuropathies, but the clinical scenario may lead you to look for these. As a screen:

1. POWER; Ask the patient to abduct the fingers and thumb against resistance.
2. COMPRESSION = Phalen's test; The patient is asked to hold their wrist in complete and forced flexion (pushing the dorsal surfaces of both hands together) for 30–60 seconds. characteristic symptoms (such as burning, tingling or numb sensation over the thumb, index, middle and ring fingers) conveys a positive test result and confirms carpal tunnel syndrome.
3. SENSATION; Test ulnar, and median nerve function by checking sensation with light touch at the following locations:
   • Palmar index finger = median nerve
   • Palmar little finger= ulnar nerve