Hand and Wrist Examination: Difference between revisions

Revision as of 19:38, 30 June 2021

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

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

Tendons

Neurological Exam

@@ Line 1: / Line 1: @@
 {{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===
+'''Dorsal Wrist Pain'''
-==Landmarks==
-===Dorsal Wrist Pain===
 [[File:dorsal-wrist-pain.jpg]]
 :A = Intersection syndrome
@@ Line 17: / Line 48: @@
 :L = ECU dislocation / tendonitis
-===Volar Wrist Pain===
+'''Volar Wrist Pain'''
 [[File:volar-wrist.jpg]]
 :A = FCU tendonitis
@@ Line 25: / Line 57: @@
 :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:Hand and Wrist]]