Physical examination maneuver
Physical Exam
Hand Inspection
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Video coming soon
How to Perform
Inspect all surfaces of both hands systematically: the skin color and temperature; the nails for shape, color, and surface (clubbing, koilonychia, pitting, splinter hemorrhages, nailfold changes); the joints for swelling or deformity; and the muscles for wasting.
How to Interpret
Showing 16 of 27 findings
Anemia
Nailbed pallor
Rule in
—
Rule out
Minimally helpful
Evidence:Moderate
Palmar pallor
Rule in
—
Rule out
Minimally helpful
Evidence:Moderate
Palmar crease pallor
Rule in
—
Rule out
Not helpfulNo CI
Evidence:Moderate
Carpal Tunnel Syndrome
Thenar atrophy
Rule in
InconclusiveWide CI
Rule out
Not helpful
Evidence:Moderate
Cirrhosis
Palmar erythema
Rule in
InconclusiveWide CI
Rule out
Minimally helpful
Evidence:Strong
Terry nails
Rule in
—
Rule out
—
Evidence:Moderate
Crohn Disease
Digital clubbing present on hand inspection
Rule in
Somewhat helpful
Rule out
Minimally helpfulNo CI
Evidence:Moderate
Hepatopulmonary Syndrome
Digital clubbing
Rule in
HelpfulDerived CI
Rule out
Somewhat helpfulWide CI
Evidence:Moderate
Palmar erythema
Rule in
Somewhat helpfulDerived CI
Rule out
Somewhat helpfulWide CI
Evidence:Moderate
Hyperthyroidism
Fine finger tremor
Rule in
Not helpfulDerived CI
Rule out
Not helpfulDerived CI
Evidence:ModerateResearch in progress
Hypoxemia
Digital clubbing in a patient with chronic lung disease
Rule in
HelpfulDerived CI
Rule out
Minimally helpfulDerived CI
Evidence:Moderate
Infective Endocarditis
Digital clubbing
Rule in
Somewhat helpfulDerived CI
Rule out
Not helpfulDerived CI
Evidence:Moderate
Splinter hemorrhages in the nail bed
Rule in
Minimally helpfulDerived CI
Rule out
Not helpfulDerived CI
Evidence:Moderate
Lung Cancer
Digital clubbing
Rule in
Somewhat helpful
Rule out
Minimally helpful
Evidence:Moderate
Osteoarthritis
Heberden nodes (DIP) and Bouchard nodes (PIP)
Rule in
Minimally helpfulDerived CI
Rule out
Somewhat helpfulDerived CI
Evidence:Moderate
Ulcerative Colitis
Digital clubbing present on hand inspection
Rule in
Somewhat helpful
Rule out
Not helpfulNo CI
Evidence:Moderate
Related Bedside Tests
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Heart Rate
Rule in:SHAtrial Fibrillation, SHDecompensation, SHHypothyroidism +15 more
Rule out:HDecompensation, SHAtrial Fibrillation, SHPostoperative Complication +15 more
🎬Video coming soon
Edema Assessment
Rule in:SHAscites, SHCirrhosis, SHCushing Syndrome +14 more
Rule out:HAscites, MHHeart Failure, NHCirrhosis +14 more
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Schamroth Sign
aka Schamroth window test
Rule in:HDigital Clubbing
Rule out:HDigital Clubbing
🎬Video coming soon
Blood Pressure
Rule in:VHHypovolemia, VHMortality, VHStructural Brain Lesion +22 more
Rule out:VHCardiac Tamponade, VHHypovolemia, HLow Cardiac Output +22 more
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Mouth and Tongue Inspection
Rule in:HHypoxemia, SHAnemia, SHHepatopulmonary Syndrome +16 more
Rule out:HHepatopulmonary Syndrome, SHHypovolemia, MHAnemia +16 more
🎬Video coming soon
Spleen Palpation
Rule in:VHSplenomegaly, HMalaria, SHCirrhosis +13 more
Rule out:SHMyelofibrosis, MHInfectious Mononucleosis, MHSplenomegaly +13 more