Introduction0/5GreetingsHand washVerify the patient's identityExplanation of the examinationObtain verbal consentGeneral Inspection0/4Assess weightLook for signs of Cushingoid appearanceCheck for iritis, scleritisNote any obvious joint diseaseLook0/5Wrist/forearm inspectionErythema, scleroderma, atrophy, scars, rashes, swelling and its distribution, muscle wastingMCPJ inspectionUlnar deviation, volar subluxation, swellingPIPJ/DIPJ inspectionSwelling, deformities (swan necking, boutonniere, Z deformity of thumb in RA), Heberden's nodes (OA), Bouchard's nodes (OA), dactylitis (Psoriatic Arthritis)Nail inspectionPsoriatic nails (hyperkeratosis, onycholysis, pitting, ridging, discoloration)Palmer surface inspectionErythema, thenar and hypothenar wasting, Dupuytren's contractureFeel and Move Passively0/10Palpate each jointCheck for synovitis, effusions, ROM, crepitus, subluxationWrist jointsRadiocarpal, ulnocarpal, distal radioulnar jointsMetacarpophalangeal joints (MCPJ)Assess all 5 MCPJsProximal interphalangeal joints (PIPJ)Assess all 5 PIPJsDistal interphalangeal joints (DIPJ)Assess all 5 DIPJsThumb joints1st carpometacarpal (CMC) joint, interphalangeal (IP) jointAssess palmer tendons for trigger finger/crepitusCarpal tunnel syndrome testsPhalen's testTinel's testActive Movement0/9Wrist movementsFlexionExtensionThumb movementsExtensionAbductionAdductionOppositionFingers: FDP/FDS testPerform if active flexion reduced in one or more fingersFunction0/3Assess grip strengthTest opposition strengthPerform practical teste.g., buttoning up a shirt, writing with a penOther0/1Assess elbowsCheck for subcutaneous nodules, psoriatic rashesConclusion0/3Thank the patientHand washSummarize findings
