Physical Exam: The Handy Hand

12 Comments / Humor, Physical Exam / By

Back to the subject at hand.
To those who are relatively new to this blog, one of the most popular…uh…tolerated series of posts has been my series on the physical exam.  If you haven\’t done so already, you may want to go back and read the posts to get in the proper mindset (or destroy enough brain cells).

Astute readers will note that doctors are not the only professionals to examine the hand.

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Long before we knew anything about carpal tunnel syndrome or the thenar eminence, we had Madam Linda and her cohorts looking at the hand for signs of what the future will bring for the individual that happens to be connected to the hand in question.  Just as stars and planets can have a peculiar interest as to whether a person will run into money, the lines on a person\’s hand can foreshadow a person\’s future.

I took an interest into why this would be the case.  What would it be that could make the creases in a person\’s hand have such predictive powers?  The classic palm-reading guide looks like this:

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So, having the scientific curiosity I have, I wondered about my hand:

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Looking at my own hand, I noticed the following:

  1. My hand is at a 90 degree angle when compared to the typical hand.  I don\’t know if this has an influence on my future; perhaps it means that I will fall over a lot or get lots of sleep.  I couldn\’t determine that from my research.
  2. The lines on my hand are lavender instead of red.  From my research, this seems to indicate that, while I do like spicy foods, \”atomic\” chicken wings are not in my future.  It also means that I should watch out for garden tools and hamsters, as they may cause me significant harm.
  3. I have a very long \”fame\” line, but my \”head\” line is not very long.  So, I suspect that while the rest of my body becomes famous, my head will be left out from the acclaim.
  4. My \”marriage\” lines are shorter than my \”travel\” lines.  This means that I don\’t go on enough trips with my wife.  She agrees with this assessment and now is a believer in palm reading (although I am not sure why she had all those lavender markers).

Some sources suggest an alternative guide to palm-reading:

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The best evidence for this interpretation is the fact that Steve Jobs has a very big line 7.  I disagree with this interpretation, as my lines 1 and 6 are quite long and I…uh….

So what about the other professionals who examine the hand…you know, doctors?  Well, we docs have our own mad skilz when it comes to examining the hand.  Here is what the typical hand exam entails:

  • Inspection of the muscles of the hand, as smaller (atrophied) muscles can indicate nerve damage.
  • Inspection of the joints, as big bumps on them can signify certain types of arthritis.
  • Checking the strength and movement of all of the joints.
  • Doing special tests that look for certain conditions.

I\’m going to ignore the 1st one, because it\’s hard to explain briefly (it\’s also hard to explain while only wearing briefs).  So let\’s move on to the other parts of the exam (and let\’s also get some clothes on, because it\’s getting a little chilly in here).

Bumps

There are two problems that cause bumps on the joints of the fingers: osteoarthritis and rheumatoid arthritis.  Osteoarthritis causes harder bumps that happen on the two joints furthest down the finger (called PIP and DIP, for proximal interphalangial and distal interphalangial joints).  These bumps have names that are basically meaningless, but are asked a lot on tests in medical school:

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I think that Bouchard and Heberden probably donated a lot to some doctor charity or threw some great parties, and so got part of the body named after them.  I don\’t see any other reason medical students are forced to learn them.

Rheumatoid arthritis (which is a much nastier disease) causes swelling of the joints at the base of the fingers (called MCP joints, for metacarpal phalange joint) as well as sometimes the PIP joint.  The swelling happens in the capsule around the joint, so it is usually softer than osteoarthritis\’ bony bumps.

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\”Affected synovium\” is the doctor way of saying: \”bump on joint that is squishy.\”

Hand Movements

\"\"The movements of the hands are best appreciated with a flashlight shining on the side of a tent.  The patient is told to make the shape of a pterodactyl and scare the sissy kids in the tent.  If they do so successfully their hands are fine (and they get a lot of laughs).  Most exam rooms, however, don\’t have tents in them (you see why our healthcare system is such a mess), so doctors instead have the person clench a fist and open their hands back up.  If the patient cannot bring the fingers to a clenched position, then the there is a problem with the muscles, joints, or tendons that help the hand close.  If they can\’t straighten the finger(s), then the muscles, joints, and tendons that do that job are messed up.  If the patient clenches the fist and leaves it closed, it signifies that the person is angry about their bill.

The tendons in the hands are line marionette strings that pull the fingers into a fist (flexion) or to straighten them (extension).  The muscles that control the tendons are in the forearm, which is a good arrangement, as having the muscles in the hand would add too much bulk to the fingers and get in the way of their function.  Breaking one or more of these tendons causes several common deformities.  The first is the \”mallet finger\” deformity, where the tendon that straightens out the tip of the finger is broken.

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These injuries are not usually serious, and are treated by splinting the finger for a few weeks.

The second deformity is called the  \”boutonniere deformity.\”  It happens when the tendon extending the middle joint of the finger gets severed while the last joint extension tendon remains intact.

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This most commonly happens when someone jams their finger, but my wife had it happen when she cut it in the kitchen with a Ginsu knife.  I am kidding, it wasn\’t Ginsu.  If this finger deformity is a complete severing of the tendon, it can be surgically repaired.  If it is not a complete injury or if it is not seen fairly soon after it happens, it can be splinted with a fairly good outcome.

What?

Is that you, Madam Linda?

What are you trying to tell me from the great beyond?

Ah, the future will hold another post about the exam of the hand because this one is going too long.  Ah, I see.  Thank you, Madam Linda.

What?

My What?

It is not big!  I swear, I\’ve been on a diet and it is much better!  I don\’t care what that stupid line says.

12 thoughts on “Physical Exam: The Handy Hand”

  1. Jabulani

    See, I'm learning…I didn't read this post with coffee in my hand. I did however burst out laughing in several places! Thanks for the giggles. Oh, and making me flex my fist to check if I was unhappy with the bill 😉

  2. kathy smith

    Wow. Never knew there was so much to say about our lil ol' hands. Very interesting and funny! 🙂 I enjoyed it!

    My hands claims to fame include my sister breaking my pinkie finger when I was 8. She pushed me and I fell back into the closet door and my finger went into the hinged area. My mom had me stick my finger in a glass of cold milk to help with the swelling (cold milk works quite well). Sadly, she didn't realize it was broken until the next day in church when she realized it was all purple and nasty looking and not getting better. Nice, huh?

    My other hand claim to fame is when I fell out of a tree when I was 12 and broke both of my wrists. After it healed, a few years down the line I realized that one of the bones in my hand near my wrist was protruding just a bit like a lump. May not be from my wrist healing bizarrely…but that's what I attribute my bony lump to.

    Oh yeah…and I hold my pencil wrong. My third grade teacher used to hit my hand every day when she saw me holding it wrong. Didn't work. So I have a large callous on my right ring finger that will probably be with me my whole life from where the pencil rests!

    Other than that, my hands are boring…

    But the blog wasn't! 🙂

  3. Val Erde

    My father (who was a doctor and is not a doctor now, not because he was struck off but because he died in 1999 and because Madame Linda says he wants you to know that,) had arthritis in his wrists and bits of his hands (for 'bits of hands', read 'some fingers'), particularly in his right index finger, and he used to shake said finger at people when he was trying to make a point. This produced a curious effect as the finger was curved. So he exaggerated the movement and the finger-shake became a sort of swirling curve… later he added to the effect and it became a sort of finger dance. It was very creative and annoying to the other person.

    It's a wonder, isn't it, what people can do with their medical conditions, to make them fun.

    Me, I wonder about creating pressed-through-stencils artwork from the oedema in my ankles (produced courtesy of a certain anti-hypertension drug that I shall not name as I do not want to be sued.)

    I enjoy your blog. Well, most of it.

  4. absurdoldbird

    My father (who was a doctor and is not a doctor now, not because he was struck off but because he died in 1999 and because Madame Linda says he wants you to know that,) had arthritis in his wrists and bits of his hands (for 'bits of hands', read 'some fingers'), particularly in his right index finger, and he used to shake said finger at people when he was trying to make a point. This produced a curious effect as the finger was curved. So he exaggerated the movement and the finger-shake became a sort of swirling curve… later he added to the effect and it became a sort of finger dance. It was very creative and annoying to the other person.

    It's a wonder, isn't it, what people can do with their medical conditions, to make them fun.

    Me, I wonder about creating pressed-through-stencils artwork from the oedema in my ankles (produced courtesy of a certain anti-hypertension drug that I shall not name as I do not want to be sued.)

    I enjoy your blog. Well, most of it.

  5. doc_rob

    When I was a kid I got hit in the eye with a baseball. It caused a huge hemorrhage on the white part of the eye (a benign condition). When I looked to the right it would look like my entire eye was bloody and people were grossed out. I thought that was the coolest thing in the world…

    I am sorry that part of my blog is not enjoyable.

  6. Alice Robertson

    Ha! This is witty and informative! How about a teaching/satire on the ear lobe crease and coronary heart disease? What a great way to learn medical science. Move over Bill Nye! <G>

  7. absurdoldbird

    Ah… that's okay. It could have been worse: it could have happened to me.
    😉

    By the by, I posted my comment twice by mistake (I'm not used to using this disqus thingy) so feel free to delete the clone of it.

  9. Martijn van Mensvoort

    Hello Doctor Rob,

    Interesting … but why focuss on such 'obscure' details?

    There is so much more going on in todays hand research, for example: UK professor John T. Manning's finger research project about the '2D:4D digit ratio'.

    An interesting introduction – including various youtube videos from the BBC's “Secrets of the Sexes” is available here:
    http://handfacts.wordpress.com/2010/04/24/will-…

    I would love to hear your review-version!!

    Greetings from The Netherlands!

    Martijn.

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