Wrist Exam

Take watch off

 

Look

 

Palm up

- thenar wasting

- STT gangion

- thumb OA

- flexor synovitis

 

Thenar Wasting

 

Thumb up

- thenar wasting

 

Palm down

- dorsal SL ganglion

- extensor synovitis

 

Palms together

- claw ulna

- elbow scars

 

Move

 

Wrist 

- extension

- flexion

- radial / ulna deviation

- pronation / supination (thumb up)

 

Finger flex and extend

- thumb in and out

- spread fingers

 

 

Feel

 

Sensation

- ulna nerve / radial / median nerve / CTS

 

Radial side

 

Distal Radius

 

1st extensor compartment

- swelling EPB / APL

- Finklestein's

- flex and extend thumb

- feel crepitus

 

Intersection

- tenderness crossover EPB APL

 

Scaphoid

- snuffbox

- tuberosity

- Watson's test

 

Base of thumb

- tenderness

- deformity

- Grind Test

 

MCPJ thumb

- tenderness

- weakness ulna collateral

 

SL joint

Wartenberg's radial neuritis

 

Ulna side

 

ECU tendon

 

Lunotriquetral joint 

- instability test 

- one under each thumb & toggle 

- look for movement or pain

 

Ulna head

- deformity

- instability

 

Hamate Hook

- tenderness with #

 

DRUJ 

- synovitis

- tenderness

- piano key

- pro/sup subluxation, pain, clicking

 

TFCC 

- palpate for tenderness distal to ulna

- Grind test circ & press

- look for pain & crepitus

 

PisoTriquetral Joint 

- occupational injury

- press & rock against Triquetrum 

- look for pain & crepitus

- similar concept to patella

 

Guyon's canal

- Tinel's

 

Other

 

Allen's test

CTS

Ulna Nerve