During the examination, the patients were seated in a comfortable position with their hands and fingers supported so as to keep a position of slight wrist extension with the metacarpophalangeal, proximal interphalangeal and the
distal interphalangeal joints in full extension.
Examination of the dorsal surface of his hands revealed multiple erythematous patches, blisters, and calluses, as well as ulcerations on the proximal and
distal interphalangeal joints (FIGURE 1).
Examination of the hands shows Heberden's nodes in the
distal interphalangeal joints of both hands.
3rd
distal interphalangeal joints, 2nd and 3rd proximal interphalangeal
Examination of this otherwise healthy-appearing woman revealed five or six vesicles, each approximately 0.5 cm in diameter, located between the proximal and
distal interphalangeal joints on the extensor surface of the third digit of the left hand.