While doing the physical examination of the hands, examine
• Nails
• Fingers
• Palm
But first, have a general look at the hand and note the following points:
• Shape
• Size
• Tremors
• Hand grip
• Muscle wasting

Shape
The shape of the hand may change in some congenital anomalies and some diseases. For example, in tenth hands, adopt a special form. Likewise, in turners syndrome, the fourth metacarpal is short, which becomes evident when the female makes a first. In the case of pseudohypoparathyroidism, the fourth and fifth metacarpals become shorter.
Size
The size of the hand is also important in diagnosing some diseases. Hands become large and broad in acromegaly(due to increased growth hormone in the period of growth of the body).
Tremors, Hand grip, Muscle wasting
Tremors are rhythmic and involuntary movements resulting from alternating contraction and relaxation of muscles.
How to look for tremors in hands
To look for tremors in the hands, outstretch the hands; if tremors are not found but suspected, put a piece of paper on the dorsum of the hand and see a moving paper which denotes tremors.
Tremors occur in anxiety, thyrotoxicosis, Parkinson’s disease etc.
Also, look for the hand grip and muscle wasting by comparing the hands on both sides.
General physical examination of nails
Nails are also important indicators of some diseases.
Look for the following signs while examining the hands:
• Pallor
• Cyanosis
• Koilonychia
• Clubbing
• Splinter haemorrhages
• Leukonychia
• Pitting of nails
• Half and half nails
Pallor
The normal colour of the nails is pink. I’m at very in different diseases. It becomes pale in anaemia(due to a decrease in red blood cells).
Cyanosis
Bluish discolouration of the nails occurs in cyanosis.
Koilonychia
Normally, nails are convex. They become thin and concave, i.e. spoon-shaped in a long-standing case

of iron deficiency anaemia.

Clubbing
Loss of the angle between the nail and the nail base is known as clubbing.
How to assess clubbing?
These ways are:
• Examine the fingers from the side profile
• Palpate the nail from the distal end to towards the base
• Place a card or paper over the nail and nail base. A gap will be left behind, which is normal. If there is no gap, it denotes the presence of clubbing.
• By shcamroth’s sign
When two corresponding fingers are approximated, the gap is left behind between the two nails. It will be absent in clubbing.
There may be swelling of the distal phalanx, which becomes bulbous and resembles the end of a

drumstick.
So, clubbing can be present in respiratory diseases(lung access, empyema, lung carcinoma), cardiovascular diseases(Fallot’s tetralogy, infective endocarditis), gastrointestinal diseases (malabsorption syndrome, ulcerative colitis)etc.
Splinter haemorrhages
These are vertical hemorrhagic streaks under the nails commonly seen in infective endocarditis.
Leuconychia
These are white patches on nail plates. They may be present in normal persons and are sometimes seen in patients with chronic liver disease.
Pitting of nails
A large number of small pits may be present in nails. They’re common in psoriasis.
Half and half nails
The proximal half of the mail is white or pink, and the distal half is red or brown in half-and-half nails, which occurs in chronic renal failure.
General physical examination of fingers
Fingers are also examined while examining the hands. Look for
• Osler’s nodes

• Heberden’s nodes

• Joint swelling
• Joint deformity
• Arachnodactyly
Osler’s nodes
Small painful swelling in the pulp of terminal phalanges is called Osler’s nodes. These are seen in infective endocarditis.
Heberden’s nodes
These are bony swellings present on the sides of terminal interphalangeal joints.
Joint swelling
Look for swelling of all interphalangeal joints. Proximal interphalangeal joints become swollen in rheumatoid arthritis, giving them a spindle shape.
Joint deformity
If arthritis persists for a long time, it causes joint deformity.
Deformities may be of one of these types
• Anterior subluxation of metacarpophalangeal joints
• Fixed flexion at the terminal interphalangeal joint and hyperextension at the proximal interphalangeal joint, also called swan neck deformity.
• If there is fixed flexion at the proximal interphalangeal joint and extension at the distal interphalangeal joint, it is called buttonhole deformity.
Arachnodactyly
It is a condition in which fingers become long and thin. It is seen in Marfan’s syndrome.
General physical examination of palm
While doing a physical examination of the palm, look for:
➡️Colour of palm
➡️Palmar erythema
➡️Sweating
➡️Dupuytren’s contracture
Colour of palm
The colour of the palm may change with different diseases. For example, it becomes pale on anaemia.
Palmar erythema
Redness of the thenar and hypothenar eminences may be seen in common individuals. Italy also be present in pregnancy and hepatic failure.
Sweating
Check for sweating on the palms. Excessive sweating may be due to anxiety or hyperthyroidism.
Dupuytren’s contracture
It is the thickening of the palmar fascia between the palm and the ring finger due to alcoholic cirrhosis.
How to present a general physical examination in front of the examiner
Here is an example of how to describe the physical examination of the hand in front of the examiner:
A healthy-looking man lying in his bed is of normal weight and height and is fully conscious. His pulse is 86/min, blood pressure 120/76, and temperature is normal. On physical examination of the hands, there is no pallor, no cyanosis, no clubbing, no koilonychia, no splinter haemorrhages, no leukonychia, no Palmer sweating or erythema. The size and shape of the hand are normal. Imetrpahlangeal joints are normal. There are no swollen joints or joint deformities. Note: Always tell the positive findings first and negative findings at last.
Conclusion
This was all about the general physical examination of hands, its findings and the diseases related to these findings.