A 55-year-old man had had muscle complaints for as long as he could remember. He could not stretch his arms or walk without shoes due to deformities of the feet. Proximal muscle weakness was mild and slowly progressive over years, and contractures had always been prominent. His stamina was low, but he still worked full-time as a manual worker. He was otherwise healthy.

Family history revealed that his father was similarly affected. In addition, a half-brother and half-sister not only had contractures but also had muscle weakness. The latter underwent surgery for torticollis in the neonatal period.

A 24-year-old man is the youngest of five children and of Turkish origin, who since the age of five years had noticed that he was not able to fully extend his arms. Furthermore, his Achilles tendons were taut. His previous history was unremarkable. An older brother had similar symptoms. Both had no cardiac symptoms. His parents were not affected.

A 12-year-old boy had a three-year history of exercise-induced pain in his limbs; in particular, the shoulders, elbows, and knees were affected. For six months he had also experienced loss of strength. He noted difficulty with walking and cycling and was hardly able to climb stairs. He developed toe walking and complained about an itchy skin rash with focal depigmentation at his neck and trunk, diagnosed as eczema. He did not complain about swallowing difficulty, yet he became cachexic because his nutritional intake was lagging, and he suffered from mood swings.

Previous history was unremarkable. His parents were healthy, as was his older brother.

In his late twenties, a 30-year-old man reported difficulty with raising his arms and running, which had progressed over subsequent years. During his teens he had been a very good soccer player.

The hand examination does not follow the pattern of the other joints such as look, feel, move. This is because there are varied pathologies in the hand and each is examined differently. The process described is to first perform a screening test that will allow the examiner to identify the pathology present and then to subsequently tailor the rest of the clinical examination. For example, if a lump is found, it will be examined differently to Dupuytren’s disease being found or to a tendon injury.

In addition, examination findings of various pathologies seen in the hand are described such as rheumatoid disease, first carpometacarpal joint arthritis and flexor tendon injuries.