The Upper Extremities

Examination of the Upper Extremities

Examination of the shoulders, arms, forearms and hands requires that the upper extremities and chest be unclothed, and that an adequate, stationary mirror and light be used.

1. Examine the movements of the hands and fingers. Note the joints with soreness or limited motion in flexing and extending the finger joints and wrist joints. Observe also any joint swelling or deformity about the finger joints, frequently indicating degenerative arthritis.

2. Examine the elbow motion. Observe any painful inability to straighten the elbows completely, or to completely twist the wrists. Such inabilities again point to possibilities of arthritis.

3. Examine the movement of the shoulder. In a standing position slowly raise the straightened arm outward from the
thigh to the horizontal position. Swing the arms forward to join in front and then backwards as far as possible. Note any pain in the shoulder joints during this action, as a probable finding of arthritis or bursitis.

4. Observe the degree of steadiness of the hands. Note especially any tremor of the fingers when held in a relaxed position, and also in a stiffened spread-out position. Tremors of the hands and fingers may mean neurological diseases,
such as Parkinsonism.

5. Examine the reflexes present in the hands. Place each hand in cold running water for a few minutes, then withdraw it and observe any severe continuous blanching of the skin, with a long delay in return of color to the hands. Severe blanching may indicate Raynaud’s Disease. Now determine the strength of the grip in each hand by squeezing the
opposite wrist in turn. A great discrepancy of strength be tween the right and left grip could be a first indication of
neurological disease.

6. Examine the hand for infection. Squeeze the palms and the back of the hands for painful swelling or redness of the skin in this region, or in the web of the thumb. These are the sites for serious hand-palm infection.

7. Examine the fingernails for infection. Observe any infected boil-like areas alongside the fingernail with any redness, swelling or pain in the fingers. Possible infections in the fingertips and about the nails are felons or nail infections.


Fig. 146. Arthritis in the hands and fingers may produce the gnarled and weakened appearance so typical of long-standing rheumatoid arthritis extending into later years of life.