Hand and Wrist Examination

This article is a stub.

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

Landmarks

Dorsal Wrist Pain

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

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