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Hand and Wrist Examination
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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
Differential Diagnoses
Acute Wrist Pain
- Distal radius fracture (often intra-articular in the athlete)
- Scaphoid Fracture
- Wrist ligament sprain/tear (intercarpal, scapholunate, lunotriquetral)
- Fracture of hook of hamate
- Triangular fibrocartilage complex tear
- Distal radioulnar joint instability
- Scapholunate dissociation
- Carpal dislocation
- Anterior dislocation of lunate
- Perilunar dislocation
- Traumatic ulnar artery aneurysm or thrombosis (karate)
- Dorsal wrist pain - Scaphoid fracture, Scaphoid impaction syndrome, Fracture dislocation of carpus, Lunate fracture, Distal radius fracture, Scapholunate ligament tear, Kienbock's disease (acute onset), Lunotriquetralligament tear, Distal radioulnar joint injury, Carpometacarpal dislocation
- Volar wrist pain - Carpal instability, Hook of hamate fracture
Subacute Dorsal Wrist Pain
- Ganglion
- Intersection syndrome
- Kienbock's disease
- Dorsal pole of lunate and distal radius impingement (gymnasts)
- Posterior interosseous nerve entrapment
- Inflammatory arthropathy
- Degenerative joint disease
- Extensor carpi ulnaris tendinopathy
- Extensor carpi ulnaris subluxation
- Injuries to distal radial epiphysis (children)
- Extensor pollicis longus impingement on Lister's tubercle (occasional rupture)
Subacute Volar Wrist Pain
- Scaphoid aseptic necrosis
- Stenosing tendinopathies
- Flexor carpi ulnaris tendinopathy
- Carpal tunnel syndrome
- Ulnar tunnel syndrome
- Pisotriquetral degenerative joint disease
- Avascular necrosis of the capitate (weightlifters)
- Extensor pollicis longus impingement/rupture (gymnasts)
Subacute Ulnar Wrist Pain
- Triangular fibrocartilage complex tears
- Ulnar Impaction syndrome
- Distal radioulnar joint instability
- Carpal instability
- Scapholunate dissociation
- Ulnar nerve compression (cyclists, golfers)
- Flexor carpi ulnaris tendinopathy
- Extensor carpi uinaris tendinopathy
- Extensor carpi ulnaris subluxation
- Distal radioulnar joint impaction syndromes (golfers)
- Scaphoid impaction syndrome
Subacute Radial Wrist Pain
- Scaphoid Fracture (missed)
- Non-union of scaphoid fracture
- De Quervain Tendinopathy
- Scaphoid impaction syndrome
- Intersection Syndrome
- Flexor carpi radialis tendinopathy
- Dorsal pole of lunate impingement on distal radius (gymnasts)
- Scapholunate dissociation
- First Carpometacarpal Joint Osteoarthritis
- Scaphotrapeziotrapezoid (STT) Joint Osteoarthritis
- Osteoarthritis of the radiocarpal joint
- Ganglia
- Radial sensory nerve entrapment in the forearm
- Crystal-induced arthritis
- C6 radicular syndrome
Carpal Tunnel Syndrome
- Cervical radicular pain (C6 or C7): Neck pain, positive Spurlings test
- First Carpometacarpal Joint Osteoarthritis : Painful thumb motion, positive grind test, radiographic findings
- De Quervain Tendinopathy: Tenderness distal radial styloid
- Polyneuropathy: History of diabetes mellitus, bilateral, lower extremity involvement.
- Thoracic Outlet Syndrome: ulnar sided symptoms, positive EAST and ULTT.
- Pronator teres syndrome (median nerve compression at the elbow): Forearm pain; sensory loss over the thenar eminence; weakness with thumb flexion, wrist extension, and forearm pronation
- Ulnar neuropathy: Paresthesias of the ring and little fingers, positive Tinel sign and compression tests at the elbow or wrist (Guyon canal)
- Radial neuropathy
- Raynaud syndrome:Symptoms related to cold exposure, typical color changes
- Vibration white finger:Use of vibratory hand power tools, symptoms of Raynaud phenomenon
- Wrist osteoarthritis: painful wrist motion, radiographic findings
- Inflammatory arthropathy
- Peripheral nerve tumour
- Multiple sclerosis
- Amyotrophic lateral sclerosis
- Acute compression syndromes (eg, Saturday night palsy)
