Wrist Examination

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Wrist Examination

• S.Fallatah
• A.Giachino
• April 24/02

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• The key to correct examination of the wrist is
  precise location of the symptoms relating to the
  underlying anatomical structures.
• A beauty of wrist examination is that almost all
  bony, articular, tendinous or vascular structures
  may be palpated through the overlying skin

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• Positioning
• Palpation
• Range of motion
• Special tests
• Bilateral comparison

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Inspection

• Observe the hand in function
• Swelling
• Rash
• Deformity
• Scars
• Color and condition of nails
• The contour of both palmer and dorsal surfaces

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Palpation

• Skin palpation
• The skin of both the palm and the palmer surface
  of the fingers is much thicker than that of the
  dorsal surface
• The skin of the fingers is fixed to bone by septa
  and small ligaments
• Check for any unusually worm or dry areas
• Particular attention to any lesions

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Bony palpation

• Start by palpating the radial and ulnar styloid
  processes(the basic reference points of the
  carpal region)
• Bones of the wrist

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• Radial styloid processtruly lateral
• Anatomic snuffbox..distal and slightly dorsal to
  the radial styloid process,becomes
  outlinedpalpable when the patient extends his
  thumb
• Scaphoid(Navicular)..the floor of the
  snuffbox,palpable on ulnar deviation of the wrist
• Trapezium/1st metacarpal articulation

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• Listers tubercle..1/3 of the way across the
  dorsum of the wrist from the radial styloid
  process
• Capitate..the largest of all the carpal bones
• Lunate
• The lunate,capitate,and the base of the 3rd
  metacarpal are in line with each other

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• Ulnar styloid process
• Triquetrium..with radial deviation of the wrist
• Pisiform
• Hook of the Hamate
• Metacarpals
• Metacarpophalangeal joints
• Phalanges

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Soft tissue palpation

• Clinical zones of the wrist and the hands
• Six extensor compartments(tunnels) and two
  flexors compartments.

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wrist

• Zone I Radial styloid process
• anatomic snuffbox,1st extensor compartement
• Zone IIListers tubercle
• 2nd,3rd, and 4th extensors compartements
• Zone III Ulnar styloid process
• 5th and 6th compartements
• Zone IV Pisiform(palmar aspect)
• FCU,Tunnel of Guyon,and ulnar artery
• Zone V
• palmaris longus,carpal tunnel,and FCR

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Hand

• Zone I Thenar eminence
• APB,OP,FPB
• Zone II Hypothenar eminence
• ADQ,OD,FDQ
• Zone III Palm
• Palmar aponeurosis fingers flexor tendons
• Zone IV Dorsum
• Extensor tendons
• Zone V Phalages
• Zone VI Tufts of the fingers