The general appearance of a hand with diffuse OA of the PIP and DIP joints can change, even without the presence of large nodes. The joints take on an enlarged appearance when compared to the size of the phalanges (Figure 5). Figure 3: Bouchard’s Node
Limited joint range of motion and pain in response to movement are reliable indicators of OA. Physicians, OTs, and PTs can administer the following examinations during the diagnostic process: ● Active range of motion (AROM) measurements should be taken using appropriately sized wrist and finger goniometers. A surface- or dorsal-based goniometer provides more expedient assessments in comparison to taking lateral measurements of the wrist and fingers (MacDermid, 2015). When measuring AROM of a digit, the proximal joint should be stabilized to give accurate measures of the distal joint. When measuring DIP flexion, the PIP can be stabilized either in extension or in flexion to encourage full gliding of the flexor digitorum profundus (FDP; see Figure 6). FIGURES 6a-g: ACTIVE RANGE OF MOTION MEASURES
OF SELECTED JOINTS Figure 6a: DIP Flexion
Note . “Heberden-Arthrose” by Drahreg01, used under Creative Commons license BY-SA 3.0 / Circle added. Figure 4: Heberden’s Node
Source: Erin Peterson
Figure 6b: PIP Flexion
Source: Erin Peterson Note: Heberden’s nodes at radial and ulnar index DIP and ulnar long DIP. Figure 5: Enlarged Joints in Diffuse Osteoarthritis of the Hand
Source: Erin Peterson
Source: Erin Peterson
EliteLearning.com/Physical-Therapy
Book Code: PTOH1324
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