General inspection

• Observe the patient: is there pain, deformity, pattern of joint involvement
• Presence/absence of
  • rashes (psoriasis, vasculitic skin rash)
  • erythema (gout, cellulitis, septic arthritis)
  • bruising (corticosteroid use, injury)
  • swelling (injury, gout, arthropathy)
  • pallor, red eye (iritis/ scleritis in spondyloarthritis or connective tissue disease)
  • Cushingoid facies (corticosteroid use)

Hand examination:

• Position the hands comfortably on a pillow or resting on the patients’ thigh.

• Always compare both hands (symmetrical or asymmetrical) and compare one joint with another or your own.

• For the hand examination it is essential to expose the arm to above the elbow.

• A wrist, elbow, shoulder and/or neck exam might be necessary in a patient with a hand complaint.

• Examine in a sequential manner depending on the patient’s presenting complaint.

• Do the changes mainly involve the small joints-PIPs and DIPs, MCPs or the wrists?

• Inspection (Look)

• Palpation (Feel)

• Move

• Hand function:

• Special tests: