Wasting of the small muscles of the hand

Published on 05/05/2015 by admin

Filed under Internal Medicine

Last modified 05/05/2015

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62 Wasting of the small muscles of the hand

Instruction

Examine this patient’s hands.

Ask the patient whether her hands are painful.

Salient features

History

• Rheumatoid arthritis

• Painful neck movements (cervical spondylosis)

• Fasciculations, weakness (motor neuron disease)

• Associated sensory loss (syringomyelia)

• Family history (Charcot–Marie–Tooth disease)

• Ascending muscle weakness (Guillain–Barré syndrome)

• Trauma to upper limbs (bilateral median and ulnar nerve lesions).

Examination

• Wasting of thenar and hypothenar eminences and dorsal interossei.

Proceed as follows:

• Look for deformity and swelling

• Look for fasciculations

• Check sensation over the hand, especially index and little fingers

• Test grip and pincer movements

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