Wrist Orthopaedic Tests

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Wrist Orthopaedic Tests
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Anterior Aspect

• Flexor Tendons
• Flexor carpi ulnaris
• Palmaris longus
• Flexor digitorum profundus
• Flexor digitorum superficialis
• Flexor pollicis longus
• Flexor carpi radialis

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Flexor Tendons
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Carpal Tunnel

• The median nerve and the finger flexion tendons
  lie within the carpal tunnel.
• This is a common site of compression neuropathy.

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Carpal Tunnel
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Guyons Canal(Ulnar Tunnel)

• The ulnar nerve and artery lie within Guyons
  tunnel.
• This is also a common site of compression
  neuropathy.

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Guyons Canal(Ulnar Tunnel)
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Posterior Aspect

• The ulnar styloid process is at the posterior
  aspect of the wrist proximal to the fifth digit.
• The radial tubercle is at the posterior aspect of
  the wrist proximal to the thumb.
• Pain the the tubercle may indicate Colles
  fracture.
• Pain at the ulnar styloid process may indicate a
  distal ulnar fracture.

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Ulnar Styloid Process and Radial Tubercle
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Posterior Aspect

• There are six fibro-osseous tunnels at the
  posterior aspect of the wrist.
• The extensor tendons to the hand pass through
  these tunnels.
• They are bound by an extensor retinaculum
  superficially.

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Extensor Tendons

• Tunnels and associated tendons
• Tunnel 1 Adductor pollicis longus, extensor
  pollicis brevis
• Tunnel 2 Extensor carpi radialis longus and
  brevis
• Tunnel 3 Extensor pollicis longus
• Tunnel 4 Extensor digitorum and extensor indexes
• Tunnel 5 Extensor digiti minimi
• Tunnel 6 Extensor carpi ulnaris

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Extensor Tendons
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Carpal Tunnel Syndrome

• Carpal tunnel syndrome is a compression
  neuropathy of the median nerve.
• Compression occurs under the flexor retinaculum
  at the wrist.

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Carpal Tunnel Syndrome
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Carpal Tunnel Syndrome

• Clinical Signs and Symptoms
• Loss of sensation of the tips of the first three
  fingers
• Hand and wrist pain
• Weakness of grip

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Tinels Wrist Sign

• Procedure Patients hand supinated. Stabilize
  the wrist with one hand. With your opposite
  hand, tap the palmar surface of the wrist with a
  neurological reflex hammer.
• Rationale Tingling along the distribution of
  the medial nerve indicates carpal tunnel
  syndrome. The cause could be any of the
  following inflammation of the flexor
  retinaculum, anterior dislocation of the lunate
  bone, arthritic changes, or tenosynovitis of the
  flexor digitorum tendons.

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Tinels Wrist Sign
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Phalens Test

• Procedure Flex both wrist and approximate them
  towards each other. Hold for 60 seconds.
• Rationale When both wrists are flexed, the
  flexor retinaculum provides increased compression
  of the medial nerve in the carpal tunnel.
  Tingling in the distribution of the median nerve
  (thumb, index finger, middle finger, and medial
  half of ring finger) indicates carpal tunnel
  syndrome.

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Phalens Test
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Reverse Phalens Test

• Procedure Instruct the patient to extend the
  affected wrist and have him grip your hand. With
  your opposite thumb, press on the carpal tunnel.
• Rationale Extending the hand and providing
  pressure over the carpal tunnel further
  constricts the tunnel. Tingling may indicate
  compression of the medial nerve.

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Reverse Phalens Test
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Ulnar Tunnel Syndrome

• The ulnar nerve travels through the tunnel of
  Guyon and innervates the muscles of the little
  and ring fingers.
• Ulnar nerve syndrome is a compression neuropathy
  of the ulnar nerve.

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Guyons Canal (Ulnar Tunnel)
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Ulnar Tunnel Syndrome

• Clinical Signs and Symptoms
• Pain over the little and ring finger
• Weakness of grip
• Difficulty with finger spreading
• Claw hand

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Ulnar Tunnel Triad

• Procedure Inspect and palpate the patients
  wrist, looking for tenderness over the ulnar
  tunnel, clawing of the ring finger, and
  hypothenar wasting.
• Rationale All of these signs are indicative of
  ulnar nerve compression possibly in the tunnel of
  Guyon.

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Ulnar Tunnel Triad
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Stenosing Tenosynovitis

• Stenosing tenosynovitis in the wrist affects the
  tendon and sheath of the abductor pollicis longus
  and extensor pollicis brevis.
• It is also termed de Quervains or Hoffmans
  disease.
• Swelling of the tendons and thickening of the
  sheaths that they pass through is due to an
  overuse condition of the wrist and thumb.

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Stenosing Tenosynovitis

• Clinical Signs and Symptoms
• Painful wrist and thumb during movement
• Swelling over the radial styloid
• Tendons and sheath tender to palpation

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Stenosing Tenosynovitis
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Finkelsteins Test

• Procedure Instruct the patient to make a fist
  with the thumb across the palmar surface of the
  hand and to stress the wrist medially.
• Rationale Making a fist and stressing it
  medially will stress the abductor pollicis longus
  and extensor pollicis brevis tendons. Pain in
  the distal styloid process of the radius
  indicates stenosing tenosynovitis of the tendons
  (de Quervains disease).

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Finkelsteins Test