Difference between revisions of "Hand and Wrist Examination"

From WikiMSK

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{{stub}}
 
{{stub}}
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==Sequence==
 +
===Inspection===
 +
 +
* Expose both limbs to the elbow
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** All aspects
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** Don’t forget forearm or ulna aspects
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* Seated, hands on pillow or desk
 +
** Posture/alignment
 +
** Tremor
 +
** Swelling
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** Colour
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** Wasting
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** Scars
 +
 +
===Movement===
 +
 +
* Wrist
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** Observe supination/pronation rhythm as you inspect
 +
** Flexion/extension
 +
** Radial/ulnar deviation
 +
** Pronation/supination
 +
* Fingers
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** Flexion/Extension
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** MCPJs – 0-90°
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** PIPJs – 0-110°
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** DIPJs – 0-90°
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** Abduction/Adduction
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* Thumb
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** Adduction, abduction, opposition, flexion, extension
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 +
===Palpation===
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 +
'''Dorsal Wrist Pain'''
  
==Landmarks==
 
===Dorsal Wrist Pain===
 
 
[[File:dorsal-wrist-pain.jpg]]
 
[[File:dorsal-wrist-pain.jpg]]
 
:A = Intersection syndrome
 
:A = Intersection syndrome
Line 17: Line 48:
 
:L = ECU dislocation / tendonitis
 
:L = ECU dislocation / tendonitis
  
===Volar Wrist Pain===
+
'''Volar Wrist Pain'''
 +
 
 
[[File:volar-wrist.jpg]]
 
[[File:volar-wrist.jpg]]
 
:A = FCU tendonitis
 
:A = FCU tendonitis
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:E = Base of thumb arthritis
 
:E = Base of thumb arthritis
  
{{Wrist Pain DDX}}
+
===Special Tests===
 +
Special Tests (depends on site of pain, ulnar, radial or mid)
 +
* Scapholunate instability - Watson test
 +
* DRUJ instability - Compression/ballotment test, Piano key, Drawer
 +
* Lunotriquetral instability – lunotriquetral ballotment test
 +
* Finkelsteins
 +
* Radiocarpal and midcarpal drawer tests
 +
* Ulnocarpal stress test
 +
* ECU subluxation
 +
* 1st CMC OA – CMC grind test, shuck test, see progressive adduction with hyperextension
 +
 
 +
===Tendons===
 +
 
 +
===Neurological Exam===
  
[[Category:Stubs]]
 
 
[[Category:Examination]]
 
[[Category:Examination]]
 
[[Category:Hand and Wrist]]
 
[[Category:Hand and Wrist]]

Revision as of 20:38, 30 June 2021

This article is a stub. Join WikiMSK to help expand it.

Sequence

Inspection

  • Expose both limbs to the elbow
    • All aspects
    • Don’t forget forearm or ulna aspects
  • Seated, hands on pillow or desk
    • Posture/alignment
    • Tremor
    • Swelling
    • Colour
    • Wasting
    • Scars

Movement

  • Wrist
    • Observe supination/pronation rhythm as you inspect
    • Flexion/extension
    • Radial/ulnar deviation
    • Pronation/supination
  • Fingers
    • Flexion/Extension
    • MCPJs – 0-90°
    • PIPJs – 0-110°
    • DIPJs – 0-90°
    • Abduction/Adduction
  • Thumb
    • Adduction, abduction, opposition, flexion, extension

Palpation

Dorsal Wrist Pain

Dorsal-wrist-pain.jpg

A = Intersection syndrome
B = De Quervain’s tenosynovitis
C = Scaphoid fracture / Wartenbergs syndrome (nerve entrapment)
D = Base of thumb arthritis
E = Ulnar collateral ligament injury
F = Carpal boss
G = Scapholunate ligament tear
H = Keinbock’s disease
I = Lunotriquetral ligament tear
J = DRUJ (distal radioulnar joint) arthritis / instability
K = Ulnar impaction / TFCC tear
L = ECU dislocation / tendonitis

Volar Wrist Pain

Volar-wrist.jpg

A = FCU tendonitis
B = Pisiotriquetral arthritis / Ulnar nerve entrapment / ulnar artery thrombosis
C = Hook of hamate fracture
D = Trigger finger
E = Base of thumb arthritis

Special Tests

Special Tests (depends on site of pain, ulnar, radial or mid)

  • Scapholunate instability - Watson test
  • DRUJ instability - Compression/ballotment test, Piano key, Drawer
  • Lunotriquetral instability – lunotriquetral ballotment test
  • Finkelsteins
  • Radiocarpal and midcarpal drawer tests
  • Ulnocarpal stress test
  • ECU subluxation
  • 1st CMC OA – CMC grind test, shuck test, see progressive adduction with hyperextension

Tendons

Neurological Exam