Medical Visual Inspection of the Hands

A medical visual inspection of the hands is incredibly informative, as the hands are often mirrors of systemic health. Many conditions, from chronic diseases to acute infections, can manifest with specific signs on the skin, nails, and joints of the hands.

I. General Impression and Overall Appearance

Posture/Position at Rest: Normally, fingers are slightly flexed and converge toward a point on the wrist. Abnormal positions may suggest neurological damage or arthritis.
Symmetry: Compare both hands for symmetry in size, shape, and appearance.
Dominant Hand: Note dominance, as it can influence muscle bulk or wear.

Handshake/Initial Contact

Temperature: Warm (fever, hyperthyroidism) or cold (Raynaud's, poor circulation).
Moisture: Clammy (anxiety, shock) or dry.
Grip Strength: Weak grip may indicate neuromuscular issues.

II. Skin and Subcutaneous Tissues

Color

Pallor: May indicate anemia.
Cyanosis: Indicates poor oxygenation.
Erythema: Suggests inflammation or infection.
Jaundice: Yellowing of skin.
Hyperpigmentation/Hypopigmentation: Altered pigmentation patches.

Lesions and Nodules

Scars: Note previous trauma or surgery.
Rashes/Dermatitis: Psoriasis, eczema, etc.

Common Nodules Found in Hands

Rheumatoid Nodules
Heberden's/Bouchard's Nodes
Ganglion Cysts
Tophi
Xanthomas

Other Skin Features

Ulcers/Sores: Can indicate poor circulation or infection.
Pitting/Edema: Localized or systemic swelling.
Telangiectasias: Small dilated blood vessels.
Janeway Lesions and Osler's Nodes: Signs of infective endocarditis.

Muscle Wasting and Abnormalities

Thenar and Hypothenar Eminence Wasting: May indicate nerve compression.
Interossei Muscle Wasting: Seen in advanced neurological or arthritic conditions.
Palmar Creases: Simian crease in Down syndrome.
Dupuytren's Contracture: Fixed flexion deformity from fibrous tissue buildup.

III. Nails

Color

Cyanosis: Peripheral hypoxia.
Pallor: Anemia.
Yellow Nails: Chronic disease, fungal infections.
Terry's Nails: Seen in liver disease, CHF, diabetes.
Lindsay's Nails: Half-and-half nails linked to renal failure.
Splinter Hemorrhages: Trauma or endocarditis.

Shape/Curvature

Clubbing: Associated with chronic hypoxia.
Koilonychia (Spoon Nails): Iron deficiency anemia.

Surface and Texture

Pitting: Psoriasis.
Beau's Lines: Illness-related growth interruption.
Onycholysis: Nail separation from bed.
Mees' Lines: Systemic illness or toxicity.

Perionychium (Nail Folds)

Paronychia: Inflammation/infection of nail folds.
Capillary Loop Changes: Seen in connective tissue diseases.

IV. Joints and Bones

Swelling

Look at MCP, PIP, DIP joints for signs of arthritis.

Redness (Erythema)

May indicate acute inflammation.

Ulnar Deviation

Seen in rheumatoid arthritis.

Swan Neck Deformity

Common in chronic rheumatoid arthritis.

Boutonnière Deformity

Characteristic of RA.

Z-thumb Deformity

Seen in RA involving the thumb.

Gouty Arthritis

Look for redness, swelling, and tenderness of joints.

Bony Prominences

Abnormal growths or tenderness may indicate disease.

Clinical Significance

By systematically inspecting these features, a medical professional can gather crucial visual cues that guide further examination, diagnostic testing, and ultimately, accurate diagnosis and management.