Physical examination maneuver

Physical Exam

Hand Inspection

🎬
Video coming September 2026

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 13 of 27 findings

Anemia

Nailbed pallor
Rule in
Somewhat helpfulDerived CI
Rule out
Minimally helpfulDerived CI
Evidence:Limited
Palmar pallor
Rule in
Minimally helpfulDerived CI
Rule out
Minimally helpfulDerived CI
Evidence:Limited
Palmar crease pallor
Rule in
Not helpfulNo CI
Rule out
Not helpfulNo CI
Evidence:Limited

Carpal Tunnel Syndrome

Thenar atrophy
Rule in
InconclusiveWide CI
Rule out
Not helpful
Evidence:Strong

Cirrhosis

Palmar erythema
Rule in
InconclusiveWide CI
Rule out
Minimally helpful
Evidence:Strong

Crohn Disease

Digital clubbing present on hand inspection
Rule in
Somewhat helpful
Rule out
Minimally helpfulNo CI
Evidence:Limited

Hepatopulmonary Syndrome

Digital clubbing
Rule in
HelpfulDerived CI
Rule out
Somewhat helpfulDerived CI
Evidence:Limited
Palmar erythema
Rule in
Somewhat helpfulDerived CI
Rule out
InconclusiveWide CI
Evidence:Limited

Hyperthyroidism

Fine finger tremor
Rule in
Very helpfulDerived CI
Rule out
Somewhat helpfulDerived CI
Evidence:Limited

Infective Endocarditis

Digital clubbing
Rule in
Somewhat helpfulDerived CI
Rule out
Not helpfulDerived CI
Evidence:Limited
Splinter hemorrhages in the nail bed
Rule in
Minimally helpfulDerived CI
Rule out
Not helpfulDerived CI
Evidence:Limited

Lung Cancer

Digital clubbing
Rule in
Somewhat helpful
Rule out
Minimally helpful
Evidence:Limited

Ulcerative Colitis

Digital clubbing present on hand inspection
Rule in
Somewhat helpful
Rule out
Not helpfulNo CI
Evidence:Limited

References

Research in progress on one or more findings above; ratings may change.

  • Razmi TM, Nampoothiri RV, Dogra S. Koilonychia in iron deficiency. QJM. 2018 Apr 1;111(4):271-272. doi:10.1093/qjmed/hcx229.
  • Ma Z, Mulder DJ, Gniadecki R, Cohen Tervaert JW, Osman M. Methods of assessing nailfold capillaroscopy compared to video capillaroscopy in patients with systemic sclerosis - a critical review of the literature. Diagnostics (Basel). 2023 Jun 28;13(13):2204. doi:10.3390/diagnostics13132204. PMID: 37443598.
  • Myers KA, Farquhar DRE. The rational clinical examination. Does this patient have clubbing? JAMA. 2001;286(3):341-347. PMID: 11466101
  • Udell JA, Wang CS, Tinmouth J, FitzGerald JM, Ayas NT, Simel DL, Schulzer M, Mak E, Yoshida EM. Does this patient with liver disease have cirrhosis? JAMA. 2012;307(8):832-842. PMID: 22357834.
  • Udell JA, Wang CS, Tinmouth J, FitzGerald JM, Ayas NT, Simel DL, Schulzer M, Mak E, Yoshida EM. Does this patient with liver disease have cirrhosis? JAMA. 2012;307(8):832-842. doi:10.1001/jama.2012.186. PMID: 22357834.
  • Alizadeh AH, Fatemi SR, Mirzaee V, Khoshbaten M, Talebipour B, Sharifian A, Khoram Z, Haj-sheikh-oleslami F, Gholamreza-shirazi M, Zali MR. Clinical features of hepatopulmonary syndrome in cirrhotic patients. World J Gastroenterol. 2006;12(12):1954-1956. PMID: 16610006.
  • Kalantri A, Karambelkar M, Joshi R, Kalantri S, Jajoo U. Accuracy and reliability of pallor for detecting anaemia: a hospital-based diagnostic accuracy study. PLoS One. 2010;5(1):e8545. doi:10.1371/journal.pone.0008545. PMID: 20049324.
  • Nardone DA, Roth KM, Mazur DJ, McAfee JH. Usefulness of physical examination in detecting the presence or absence of anemia. Arch Intern Med. 1990;150(1):201-204. PMID: 2297289.
  • Indra R, Patil SS, Joshi R, Pai M, Kalantri SP. Accuracy of physical examination in the diagnosis of hypothyroidism: a cross-sectional, double-blind study. J Postgrad Med. 2004;50(1):7-11. PMID: 15047991.
  • Barker DJ, Bishop JM. Computer-based screening system for patients at risk of hypothyroidism. Lancet. 1969;2(7625):835-838. PMID: 4186294.
  • Nordyke RA, Gilbert FI Jr, Harada ASM. Graves' disease: influence of age on clinical findings. Arch Intern Med. 1988;148(3):626-631. PMID: 3341864. doi:10.1001/archinte.148.3.626.
  • Paton JY, Bautista DB, Stabile MW, Waldman AE, Nassar AG, Platzker AC, Keens TG. Digital clubbing and pulmonary function abnormalities in children with lung disease. Pediatr Pulmonol. 1991;10(1):25-29. PMID: 2003043.
  • Richet H, Casalta JP, Thuny F, et al. Development and assessment of a new early scoring system using non-specific clinical signs and biological results to identify children and adult patients with a high probability of infective endocarditis on admission. J Antimicrob Chemother. 2008;62(6):1434-1440. PMID: 18952617.
  • Schwiebert R, Baig W, Wu J, Sandoe JAT. Diagnostic accuracy of splinter haemorrhages in patients referred for suspected infective endocarditis. Heart. 2022;108(24):1986-1990. doi:10.1136/heartjnl-2022-321052. PMID: 35842232.
  • D'Arcy CA, McGee S. The rational clinical examination. Does this patient have carpal tunnel syndrome? JAMA. 2000;283(23):3110-3117. PMID: 10865306
  • Choi JW, Kim BR, Seo E, Youn SW. Could psoriatic arthritis be easily diagnosed from current suspicious physical findings in the dermatology clinic? Ann Dermatol. 2017;29(1):48-54. doi:10.5021/ad.2017.29.1.48. PMID: 28223746.
  • Attali P, Ink O, Pelletier G, et al. Dupuytren's contracture, alcohol consumption, and chronic liver disease. Arch Intern Med. 1987;147(6):1065-1067. PMID: 3592873.
  • Cicuttini FM, Baker J, Hart DJ, Spector TD. Relation between Heberden's nodes and distal interphalangeal joint osteophytes and their role as markers of generalised disease. Ann Rheum Dis. 1998;57(4):246-248. PMID: 9709182.
  • Aletaha D, Neogi T, Silman AJ, et al. 2010 rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Arthritis Rheum. 2010;62(9):2569-2581. PMID: 20699241.
  • Medd WE, French EB, Wyllie VM. Cyanosis as a guide to arterial oxygen desaturation. Thorax. 1959;14(3):247-250. PMC1018507.
  • Bickley LS, Szilagyi PG, Hoffman RM, Soriano RP. Bates' Guide to Physical Examination and History Taking. 13th ed. Philadelphia, PA: Wolters Kluwer; 2021.
  • Swartz MH. Textbook of Physical Diagnosis: History and Examination. 9th ed. Philadelphia, PA: Elsevier; 2025.

Research last updated September 10, 2026.

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