A Practical Guide to Clinical Medicine
A comprehensive physical examination and clinical education site for medical students and other health care professionals
|Introduction||Breast Exam||Write Ups|
|History of Present Illness||Male Genital/Rectal Exam||The Oral Presentation|
|The Rest of the History||The Upper Extremities||Outpatient Clinics|
|Review of Systems||The Lower Extremities||Inpatient Medicine|
|Vital Signs||Musculo-Skeletal Exam||Clinical Decision Making|
|The Eye Exam||The Mental Status Exam||Physical Exam Lecture Series|
|Head and Neck Exam||The Neurological Exam||A Few Thoughts|
|The Lung Exam||Putting It All Together||Commonly Used Abbreviations|
|Cardiovascular Exam||Medical Links||References|
|Exam of the Abdomen|
The "daVinci Anatomy Icon" denotes a link to related gross anatomy pictures.
Exam of the hands and arms is usually quite brief in the asymptomatic patient. Pay particular attention to the following:
|Nicotine Staining||Onychomycosis: Fungal Infection of the Nail||Onycholysis: Separation of Nail from Underlying Bed, often due to onychomycosis||Paronychia: Infection of skin adjacent to nail of middle finger|
of the fingers secondary to severe
peripheral vascular disease.
|Peripheral Vascular Disease, Hand
And a few words about uncommonly encountered abnormalities... The presence or absence of these findings are frequently mentioned in clinical medicine, giving the impression that they are common and/or of great importance. This is more myth then fact as most patients with the disease states in question do not have these findings. Their clinical utility tends to be over emphasized.
Right upper extremity DVT. Note diffuse swelling.
Lymph Nodes of the Upper Extremity:
Epitrochlear Nodes: Found on the inside of the upper arm, just above the elbow. These are rarely the site of pathology and thus not routinely examined. If there is clinical evidence of an infection distal to the elbow, it makes sense to feel for these nodes as they are part of the drainage pathway. To examine, cup the patient's elbow in your hand (left elbow with right hand and vice versa) and palpate just above the elbow, along the inside of the upper arm. When inflamed, the nodes become large and tender.
Axillary Nodes: Pathologic enlargement occurs most commonly in the following settings:
If you feel any abnormalities, repeat the exam of each axilla separately. When examining the left axilla, grasp the patient's left wrist or elbow with your left hand and lift their arm up and out laterally. Then use your right hand to examine the axillary region as described above. This technique permits the patient's arm to remain completely relaxed, minimizing tension in the surrounding tissues that can mask otherwise enlarged lymph nodes. The right axilla is examined in a similar fashion, though hand positioning is reversed. This examination may also be performed while the patient is supine, as would be done if you were to couple it with the female breast exam.
Most patients do not have palpable axillary nodes. If you are able to feel adenopathy, make note of the following characteristics:
Left Axillary Adenopathy
|home | Clinical Images | Curricular Resources | For Our Students | BioMed Library | Web Resources | SOM 201 (ICM) Course | Next|
Copyright ©1997-2008, The Regents of the University of California.
All rights reserved. Last updated 8/16/2008.