Introduction
Inspection
- Inspection consist of describing all the abnormality of the hands, or the relevant negatives (psoriatic plaque etc).If patient have 5 important abnormality but you mention 4, then your mark shall be 4/5 of 1 mark.geddit? XD
Warmth and tenderness
- Palpate for warmth and compare with the upper part of the arm
- Palpate for tenderness at each joint, at BOTH SIDES OF THE JOINT, not above and below it. No need to move the finger around (checking for mobility n what not), you're just trying to look tenderness of which joint
How to palpate the joint
Screening : OK sign (+ prayer sign. But if you miss this, its still ok)
- Most importantly when doing screening is that you know what's its for
- OK sign:- radial, ulnar and median nerve function.
- Prayer sign :- to see if the deformity is it fixed or is still reversible
- ****usually in RA, patient don't have nerve prob so if the radial, median n ulnar nerve are normal from the OK sign no need to do special test to confirm these nerve problems.But if they have, then know which sign is for which nerve prob (Homan's test, phalen, tinnel, etc)
Power and Functionality
- Test for power of each fingers
- Function as usual : comb hari, button unbotton, use key...
Diagnosis
- RA
Differential Diagnosis
- Psoriatic arthritis
- Overlap syndrome
Ix and Mx
- Ix : Rheumatoid factor & anti CCP
- Mx :DMMARDs- Methotrexate
Settle!
