Examination -- Hand and Wrist.
Introduce and take consent.
Inspection: look at both hands together for bruising, swelling, wasting of the hypothenar muscles.
Nails: clubbing, koilonychia, leukonychia, pitting, splinter haemorrhages; cyanosis; nicotine staining; palmar erythema; pallor; dypuytren's contractures; scars; sinuses; sweating; finger changes for arthritis; rheumatoid nodules; Bouchard's and Heberden's nodes; Osler's nodes; pulmonary osteoarthropathy.
Palpation: radial pulse, radial styloid, scaphoid tubercle, proximal pole, distal radio ulnar joint, anatomical snuffbox and base of 1st metacarpal.
Movements: active: dosi flexion, ventral flexion, pronation, supination, radial deviation, ulnar deviation. Then passive to confirm.
Radial pulse, brief neurological examination and check functional movements at the clavicle, shoulder and elbow.
Power grip, pinch grip, key grip, and opponence.