Physical Exam Wrist

Introduction

• Follows the IP-PASS examination methodology
  • Inspection
  • Palpation
  • Passive Range of Motion
  • Active Range of Motion
  • Strength & Neurovascular
  • Special Tests

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Inspection

• Skin
  • Color: erythema, ecchymosis, white, black
  • Trophic changes (altered hair growth, sweat production)
• Scars
• Swelling
• Muscle tone
  • Atrophy, hypertrophy
• Deformity: asymmetry, rotation, amputation

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Palpation

• Joint Effusion
• Clicking
• Snapping
• Crepitus
• Tenderness
• Temperature
• Masses

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Range of Motion

• Wrist
  • Flexion: 80°-90°
  • Extension: 60°-70°
  • Radial Deviation: 15°-20°
  • Ulnar Deviation: 40°-60°

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Strength

• Extensors
  • Extensor Carpi Radialis Longus
  • Extensor Carpi Radialis Brevis
  • Extensor Carpi Ulnaris
• Flexors
  • Flexor Carpi Radialis
  • Flexor Carpi Ulnaris
  • Palmaris Longus
• Ulnar Deviation
  • Flexor Carpi Ulnaris
  • Extensor Carpi Ulnaris
• Radial Deviation
  • Extensor Carpi Radialis Longus
  • Extensor Carpi Radialis Brevis
  • Flexor Carpi Radialis
• Supination
  • Supinator
  • Brachioradialis
  • Biceps Brachii
• Pronation
  • Pronator Teres
  • Pronator Quadratus

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Neurovascular

• Sensation
  • Recommend: 2 point discrimination (use paper clip)
  • Light touch
• Motor Nerves:
  • Median Nerve: “A-OK” sign: flexion of the thumb and index finger or thumb and pinky against resistance
  • Ulnar Nerve: Test fingers against resistance in abduction
  • Radial Nerve: Test thumb extension against resistance
  • Anterior Interosseus Nerve: “A-OK” sign
  • Posterior Interosseus Nerve: Most hand and wrist extensors
• Vascular
  • Radial pulse
  • Ulnar pulse
  • Allen’s Test

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Special Tests

• De Quervains Tenosynovitis
  • Finkelstein's Test
  • Eichhoff's Test
  • WHAT Test
• TFCC Injury
  • TFCC Shear Test
  • TFCC Stress Test
  • Fovea Sign
  • Supination Lift Test
  • Sharpeys Test
  • Piano Key Test
  • Press Test
• Wartenbergs Syndrome
  • Tinel’s Test
  • Finkelstein's Test
• Carpal Tunnel Syndrome
  • Tinel’s Test
  • Phalen’s Test
  • Durkans Test
  • Square Wrist Sign
  • Closed Fist Sign
  • Reverse Phalens Test
• Scapholunate Instability
  • Scaphoid Shift Test
• Lunotriquetral Instability
  • Reagan's Test
  • Kleinman’s Shear Test
• Distal Radial Ulnar Joint Instability
  • Piano Key Test
  • DRUJ Compression Test
• Carpometacarpal Arthritis
  • Thumb CMC Grind Test
• Pronator Teres Syndrome
  • Pronator Teres Syndrome Test
  • Resisted Elbow Flexion And Forearm Supination Test
  • Tinels Test
  • Phalens Test
  • Resisted Elbow Extension And Forearm Pronation Test
• Extensor Carpi Ulnaris Instability
  • Ice Cream Scoop Maneuver

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See Also

• Internal
  • Hand and Wrist Anatomy (Main)
  • Forearm Pain (Main)
  • Wrist Pain (Main)
  • Finger Pain (Main)
• External
  • Sports Medicine Review Wrist Pain: https://www.sportsmedreview.com/by-joint/wrist/
  • JAMA: Examination of the Hand and Wrist

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