Table 3 Summary of the items retained from the Delphi process.

General questions:

Do you have problems with one or both hands?

Do you have any previous history of the same type of problem?

When did your symptoms start?

How did your symptoms start-were there any identifiable incidents?

Have you ever had surgery or injuries to your hands? If so when and what?

Are your symptoms getting worse, better or about the same since they started?

How is your general health?

Do you have any illnesses e.g. diabetes, heart condition or arthritis?

Do you have any problems anywhere else with your joints or muscles?

Are you on any medication or having any other medical treatment at the moment?

Are you right or left handed?

What have you done so far to get relief?

Have you had to take time off work or stop work because of your symptoms?

Specific symptom questions:

Where do you have the pain?

When does the pain occur-at night, with usage, at rest or does it hurt all the time?

What makes it better/worse?

Does pain limit your activities?

Do you experience any thumb pain during activity, e.g. writing, carrying a plate, or turning a key in a lock?

Do you experience stiffness?

Have you noticed any swelling in your hand or puffiness in your fingers?

Do you have any altered sensation (e.g. pins and needles, tingling or numbness) in any part of your hand?

Do you think your strength has decreased?

Function questions:

What are you not able to do now that you were able to do before the onset of this problem?

What is involved with your job?

Other questions:

Have you had any neck, shoulder or elbow problems-now or in the past?

Examinations:

Observation of upper limb/hand posture/use of hand

Observation of swelling

Observation of muscle wasting

Observation of skin condition: colour/pallour/discolouration/cyanosis/redness/Raynaud's

Observation of overall pattern of deformity at rest

Observation of deformity on use-what doesn't work properly

Observation of wrist deformity-subluxed carpus, radial or ulnar deviation, supinated or pronated carpus

Observation of MCP joint deformity-subluxed, radial/ulnar drift, hyperextension

Observation of PIP joint deformity-flexion contracture, hyperextension or lateral deformity, swan neck, Boutonierre

Palpation of swelling

Palpation of pain/tenderness

Palpation of CMC joint/thumb base for pain

Assessment of neck

Specific tests:

Phalen's test (carpal tunnel syndrome)

Evaluation of range of movement:

Ability to make a full fist

Ability to flatten hand onto a flat surface

Evaluation of muscle power:

Power grip strength

Evaluation of sensation:

Light touch/threshold testing (e.g. monofilaments/general map)

Assessment of function:

Broad hand function-activities of daily living