Physical examination OA of the hand and wrist is considerably troublesome to clients who have OA because hands are used extensively for daily tasks. It is especially disabling when movement at the base of the thumb and distal fingers is restricted. Pain increases during gripping or pinching movements, which interferes with activities of daily living (ADL), work, and leisure. The hands and wrists should be inspected for bony alignment, redness, swelling, and bony asymmetries. Proximally, Bouchard’s nodes, which are bony nodules on the PIP joints, might be found (Figure 3). Distally, Heberden’s nodes, presenting as hard nodules or enlargements on the DIP joints, might be observed (Figure 4; Kalichman & Hernández-Molina, 2010). Figure 3: Bouchard’s Node
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 5: Enlarged Joints in Diffuse Osteoarthritis of the Hand
Source: Erin Peterson
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).
Note . “Heberden-Arthrose” by Drahreg01, used under Creative Commons license BY-SA 3.0 / Circle added.
Figure 4: Heberden’s Node
FIGURES 6a-g: ACTIVE RANGE OF MOTION MEASURES OF SELECTED JOINTS Figure 6a: DIP Flexion
Source: Erin Peterson. Note: Heberden’s nodes at radial and ulnar index DIP and ulnar long DIP.
Source: Erin Peterson
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