Physical Exam

Hand Inspection

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Video coming September 2026

How to Perform

Inspect both hands and nails 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. Have the patient turn the hands palms up and down, and observe both at rest and during movement.

How to Interpret

Crohn Disease

Digital clubbing present on hand inspection

Rule in

Somewhat helpful

Rule out

—

Evidence:Limited

Lung Cancer

Digital clubbing present on hand inspection

Rule in

Somewhat helpful

Rule out

—

Evidence:Limited

Ulcerative Colitis

Digital clubbing present on hand inspection

Rule in

Somewhat helpful

Rule out

—

Evidence:Limited

References

Razmi TM, Nampoothiri RV, Dogra S. Koilonychia in iron deficiency. QJM. 2018 Apr 1;111(4):271-272. doi:10.1093/qjmed/hcx229. [Named clinical-image report; no diagnostic-accuracy data. Koilonychia -> iron deficiency has no study reporting sensitivity or specificity; the ~5.4% prevalence-in-disease figure (StatPearls NBK559311) is not a measure of diagnostic accuracy.]
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. [Named candidate; INSTRUMENTED techniques (videocapillaroscopy gold standard; dermatoscope sensitivity ~60% / specificity ~93%) -- not naked-eye hand inspection, whose accuracy is unreported.]
Myers KA, Farquhar DRE. The rational clinical examination. Does this patient have clubbing? JAMA. 2001 Jul 18;286(3):341-347. doi:10.1001/jama.286.3.341. PMID: 11466101.
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.