Orthopedics Book


Wrist Exam

Aka: Wrist Exam
  1. See Also
    1. Wrist Anatomy
    2. Wrist Injury (Includes summarized exam)
    3. Scaphoid Fracture Signs
    4. Hand Injury (Includes summarized exam)
    5. Hand Anatomy
    6. Hand Exam
  2. Exam: Normal Range of Motion
    1. Wrist flexion: 70 degrees
    2. Wrist extension: 70 degrees
    3. Ulnar deviation: 40 degrees
    4. Radial deviation: 20 degrees
    5. Forearm supination: 80 degrees
    6. Forearm pronation: 80 degrees
  3. Exam: Triangular Fibrocartilage Complex (TFCC)
    1. Locate depression between Pisiform and ulnar styloid
      1. Tenderness distal to this point suggests TFCC Injury
    2. Patient and examiner shaking hands
      1. Patient tries to supinate or pronate wrist
      2. Pain or decreased ROM suggests TFCC Injury
  4. Exam: Bony Landmarks on Volar Surface
    1. Images
      1. OrthoWristVolarExam.jpg
    2. Pisiform
      1. Ulnar side of palm just proximal to palmar crease
      2. Flexor carpi ulnaris inserts on Pisiform
        1. Identify by opposing thumb and fifth finger
      3. Assess for tenderness at bony prominence
    3. Hook of Hamate
      1. Hypothenar wrist, 1 cm distal to flexor crease
      2. Identification Method 1
        1. Start at Pisiform
        2. Move 1-2 finger breadths toward midline
      3. Identification Method 2
        1. Start with examiners thumb IP on Pisiform
        2. Direct thumb toward Index finger
        3. Thumb fingertip will rest over Hamate
      4. Flex wrist and hook of Hamate becomes prominent
      5. Palmaris longus (if present) courses above Hamate
        1. Identify by opposing thumb and fifth finger
        2. Absent in 10% of patients
        3. Do not confuse with flexor carpi radialis
    4. Scaphoid tubercle
      1. Palpable at extensor carpi radialis at palmar crease
      2. Press at rest to assess for tubercle Fracture
        1. See Scaphoid Fracture Signs
      3. Press while moving from ulnar to radial deviation
        1. See Scaphoid Shift Test
  5. Exam: Bony Landmarks on Dorsal Surface
    1. Images
      1. OrthoNormalWristXray.png
    2. Anatomic Snuff box
      1. Radial border
        1. Extensor pollicis brevis
        2. Abductor pollicis longus
      2. Ulnar border
        1. Extensor pollicis longus
    3. Scaphoid distal pole
      1. Located at anatomic snuff box
      2. More easily palpated with wrist in ulnar deviation
      3. Scaphoid is the most commonly Fractured Carpal Bone
      4. See Scaphoid Fracture Signs
    4. Carpal Bones on radial side of wrist
      1. Shuck Test evaluates for inflammation/instability
    5. Triscaphe Joint
      1. Thumb follows second finger proximally over dorsum
      2. Thumb falls into triscaphe joint depression
    6. Lister's Tubercle (Radial Tubercle)
      1. Distal radius prominence on wrist dorsum
      2. Palpate radius dorsum while patient flexes wrist
      3. Lines up with Third Metacarpal
        1. Lister's Tubercle
        2. Lunate
        3. Capitate
        4. Third Metacarpal
    7. Scapholunate joint or interval
      1. Most common carpal dislocation
      2. Scaphoid Shift Test evaluates scapholunate injury
      3. Identification (1.5 cm distal to Lister's Tubercle)
        1. Examiners finger starts over Third Metacarpal
        2. Trace Third Metacarpal proximally over dorsum
        3. Examiner's finger falls into depression
        4. Depression represents scapholunate joint
    8. Lunate
      1. Second to Scaphoid as most common wrist Fracture
      2. Identification
        1. Identify with patient flexing wrist
          1. Most prominent area on dorsum of flexed wrist
        2. Lunate sits on ulnar side of scapholunate joint or
        3. Follow Lister's tubercle distally to 3rd Metacarpal
  6. Exam: Specific to Wrist Overuse syndromes
    1. See Overuse Syndromes of the Hand and Wrist
    2. Carpal Tunnel Syndrome (Phalen's Test, Tinel's Test)
    3. De Quervain's Tenosynovitis (Finkelstein Test)
    4. Intersection Syndrome (tender at dorsal distal radius)
  7. References
    1. Hoppenfeld (1976) Exam Spine/Extremities, p. 59-104
    2. Daniels (2004) Am Fam Physician 69(8):1941-48 [PubMed]
    3. Forman (2005) Am Fam Physician 72:1753-8 [PubMed]

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