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Wrist and Hand Examina.on Daniel Lueders, MD Assistant Professor Physical Medicine and Rehabilita.on

Wrist and Hand Examinaon...Objecves • Understand the osseous, ligamentous, tendinous, and neural anatomy of the wrist and hand • Outline palpable superficial landmarks in the

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Page 1: Wrist and Hand Examinaon...Objecves • Understand the osseous, ligamentous, tendinous, and neural anatomy of the wrist and hand • Outline palpable superficial landmarks in the

WristandHandExamina.on

DanielLueders,MDAssistantProfessorPhysicalMedicineandRehabilita.on

Page 2: Wrist and Hand Examinaon...Objecves • Understand the osseous, ligamentous, tendinous, and neural anatomy of the wrist and hand • Outline palpable superficial landmarks in the

Objec.ves

•  Understandtheosseous,ligamentous,tendinous,andneuralanatomyofthewristandhand

•  Outlinepalpablesuperficiallandmarksinthewristandhand

•  Outlineevalua.onofanddifferen.a.onbetweennervestothewristandhand

•  Describespecialtes.ngofwristandhand

Page 3: Wrist and Hand Examinaon...Objecves • Understand the osseous, ligamentous, tendinous, and neural anatomy of the wrist and hand • Outline palpable superficial landmarks in the

WristAnatomy

•  Radius

•  Ulna

•  Carpalbones

Page 4: Wrist and Hand Examinaon...Objecves • Understand the osseous, ligamentous, tendinous, and neural anatomy of the wrist and hand • Outline palpable superficial landmarks in the

WristAnatomy

•  Radius

•  Ulna

•  Carpalbones

Page 5: Wrist and Hand Examinaon...Objecves • Understand the osseous, ligamentous, tendinous, and neural anatomy of the wrist and hand • Outline palpable superficial landmarks in the

WristAnatomy

•  Radius

•  Ulna

•  Carpalbones

Page 6: Wrist and Hand Examinaon...Objecves • Understand the osseous, ligamentous, tendinous, and neural anatomy of the wrist and hand • Outline palpable superficial landmarks in the

WristAnatomy

•  Radius

•  Ulna

•  Carpalbones

Page 7: Wrist and Hand Examinaon...Objecves • Understand the osseous, ligamentous, tendinous, and neural anatomy of the wrist and hand • Outline palpable superficial landmarks in the

Inspec.on

•  Ecchymosis

•  Erythema

•  Deformity

•  Lacera.on

Page 8: Wrist and Hand Examinaon...Objecves • Understand the osseous, ligamentous, tendinous, and neural anatomy of the wrist and hand • Outline palpable superficial landmarks in the

Inspec.on

•  CommonFingerDeformi.es

•  SwanNeckDeformity

•  BoutonniereDeformity

•  Hypertrophicnodules•  Heberden’s,Bouchard’s

Page 9: Wrist and Hand Examinaon...Objecves • Understand the osseous, ligamentous, tendinous, and neural anatomy of the wrist and hand • Outline palpable superficial landmarks in the

Inspec.on

•  SwanNeckDeformity•  PIPhyperextension,DIPflexion•  PathologyisatPIPjoint•  Insufficiencyofvolar/palmarplateand

suppor.ngstructures•  Distally,theFDPtendon.ghtensfromPIP

extensioncausingsecondaryDIPflexion•  Alterna.vely,extensortendonruptureproduces

similardeformity

Page 10: Wrist and Hand Examinaon...Objecves • Understand the osseous, ligamentous, tendinous, and neural anatomy of the wrist and hand • Outline palpable superficial landmarks in the

Inspec.on

•  BoutonniereDeformity•  PIPflexion,DIPhyperextension•  PathologyisatPIPjoint•  Commonlyoccursfrominsufficiencyofdorsal

andlateralsuppor.ngstructuresatPIPjoint•  Lateralbandsmigratevolar/palmar,crea.ng

increasedflexionmoment•  ResultsinPIP“buTonhole”effectdorsally

Page 11: Wrist and Hand Examinaon...Objecves • Understand the osseous, ligamentous, tendinous, and neural anatomy of the wrist and hand • Outline palpable superficial landmarks in the

Inspec.on

•  Nodules•  Osteoarthri.c•  HypertrophicchangesofOA•  PIP-Bouchard’snodule•  DIP-Heberden’snodule

•  RheumatoidArthri.s•  MCPjointsaffectedmost•  Distalradioulnarjointcanalsobeaffected•  Synovi.sprocess=swelling,erythema,pain

Page 12: Wrist and Hand Examinaon...Objecves • Understand the osseous, ligamentous, tendinous, and neural anatomy of the wrist and hand • Outline palpable superficial landmarks in the

Palpa.on

•  Systema.cpalpa.onisessen.alforaccuratediagnosis•  Localizepointsofmaximaltenderness•  Alwayscomparetooppositeside

Page 13: Wrist and Hand Examinaon...Objecves • Understand the osseous, ligamentous, tendinous, and neural anatomy of the wrist and hand • Outline palpable superficial landmarks in the

Scaphoid

•  Prominenceatthethenareminenceanddistalendofthepalpabletendonoftheflexorcarpiradialis

•  Thescaphoidtuberclerepresentsthepalmarprojec.onofthescaphoid

Page 14: Wrist and Hand Examinaon...Objecves • Understand the osseous, ligamentous, tendinous, and neural anatomy of the wrist and hand • Outline palpable superficial landmarks in the

Scaphoid

•  Hasaproximalpole,awaist,andadistalpole

•  ProximalPole•  Palpablejustdistalto

Lister’stubercle

Page 15: Wrist and Hand Examinaon...Objecves • Understand the osseous, ligamentous, tendinous, and neural anatomy of the wrist and hand • Outline palpable superficial landmarks in the

Scaphoid

•  Hasaproximalpole,awaist,andadistalpole

•  Waist•  Locatedwithin

anatomicsnuZox

Page 16: Wrist and Hand Examinaon...Objecves • Understand the osseous, ligamentous, tendinous, and neural anatomy of the wrist and hand • Outline palpable superficial landmarks in the

Scaphoid

•  Hasaproximalpole,awaist,andadistalpole

•  DistalPole•  Palpablejustdistalto

palmarwristcrease•  Becomesmore

prominentwithwristradialdevia.on

Page 17: Wrist and Hand Examinaon...Objecves • Understand the osseous, ligamentous, tendinous, and neural anatomy of the wrist and hand • Outline palpable superficial landmarks in the

Lunate

•  Inlinewith3rdmetacarpal•  Palpablewithinadepression

justulnartoscaphoidproximalpoleandulnartoextensorcarpiradialistendons•  Wristdorsiflexionà

Increasesdepression•  WristextensionàFullness

emerges

Page 18: Wrist and Hand Examinaon...Objecves • Understand the osseous, ligamentous, tendinous, and neural anatomy of the wrist and hand • Outline palpable superficial landmarks in the

Triquetrum

•  UlnarlobepalpablewithintheulnarsnuZoxjustdistaltotheulnarhead/styloidprocess

•  Dorsallobepalpableondorsalwristjustdistaltoulnarhead

Page 19: Wrist and Hand Examinaon...Objecves • Understand the osseous, ligamentous, tendinous, and neural anatomy of the wrist and hand • Outline palpable superficial landmarks in the

Lunate

•  Inlinewith3rdmetacarpal•  Palpablewithinadepression

justulnartoscaphoidproximalpoleandulnartoextensorcarpiradialistendons•  Wristdorsiflexionà

Increasesdepression•  WristextensionàFullness

emerges

Page 20: Wrist and Hand Examinaon...Objecves • Understand the osseous, ligamentous, tendinous, and neural anatomy of the wrist and hand • Outline palpable superficial landmarks in the

Triquetrum

•  UlnarlobepalpablewithintheulnarsnuZoxjustdistaltotheulnarhead/styloidprocess

•  Dorsallobepalpableondorsalwristjustdistaltoulnarhead

Page 21: Wrist and Hand Examinaon...Objecves • Understand the osseous, ligamentous, tendinous, and neural anatomy of the wrist and hand • Outline palpable superficial landmarks in the

Pisiform

•  Palpableonthepalmaraspectofthewrist,justdistaltotheFCUtendon,whichaTachestothepisiform

Page 22: Wrist and Hand Examinaon...Objecves • Understand the osseous, ligamentous, tendinous, and neural anatomy of the wrist and hand • Outline palpable superficial landmarks in the

Pisiform

•  Pisotriquetralar.cula.oncanbepassivelymoved•  Passivewristflexion

relaxesFCUtendon•  Permitsexaminerto

movethepisiformrela.vetotriquetrum

Page 23: Wrist and Hand Examinaon...Objecves • Understand the osseous, ligamentous, tendinous, and neural anatomy of the wrist and hand • Outline palpable superficial landmarks in the

Trapezium

•  Palmarsurfacepalpablejustdistaltoscaphoidtubercle

•  DorsalsurfacepalpableindistalaspectofanatomicsnuZox

Page 24: Wrist and Hand Examinaon...Objecves • Understand the osseous, ligamentous, tendinous, and neural anatomy of the wrist and hand • Outline palpable superficial landmarks in the

Trapezoid

•  Dorsalsurfacepalpablejustproximaltothebaseofthesecondmetacarpal,deeptotheECRLtendon

Page 25: Wrist and Hand Examinaon...Objecves • Understand the osseous, ligamentous, tendinous, and neural anatomy of the wrist and hand • Outline palpable superficial landmarks in the

Capitate

•  Dorsalsurfacepalpablejustdistaltothelunateandproximaltothebaseofthe3rdmetacarpal,deeptotheECRBandEDCtendons

Page 26: Wrist and Hand Examinaon...Objecves • Understand the osseous, ligamentous, tendinous, and neural anatomy of the wrist and hand • Outline palpable superficial landmarks in the

Hamate

•  Dorsalsurfacepalpablejustulnartotriquetrumandproximaltothe4thand5thmetacarpalbases

Page 27: Wrist and Hand Examinaon...Objecves • Understand the osseous, ligamentous, tendinous, and neural anatomy of the wrist and hand • Outline palpable superficial landmarks in the

Hamate

•  Hookofhamateispalpableonthepalmarsurfaceaboutonefingerwidthdistalandulnartopisiform

Page 28: Wrist and Hand Examinaon...Objecves • Understand the osseous, ligamentous, tendinous, and neural anatomy of the wrist and hand • Outline palpable superficial landmarks in the

Radius

•  Radialstyloid

•  Lister’stubercle

•  Ar.culateswithdistalulna

Page 29: Wrist and Hand Examinaon...Objecves • Understand the osseous, ligamentous, tendinous, and neural anatomy of the wrist and hand • Outline palpable superficial landmarks in the

Radius

•  Radialstyloid

•  Lister’stubercle

•  Ar.culateswithdistalulna

Page 30: Wrist and Hand Examinaon...Objecves • Understand the osseous, ligamentous, tendinous, and neural anatomy of the wrist and hand • Outline palpable superficial landmarks in the

Radius

•  Radialstyloid

•  Lister’stubercle

•  Ar.culateswithdistalulna

Page 31: Wrist and Hand Examinaon...Objecves • Understand the osseous, ligamentous, tendinous, and neural anatomy of the wrist and hand • Outline palpable superficial landmarks in the

DistalRadialUlnarJoint

•  Palpablebetweendistalradiusanddistalulna

•  Ar.culatesinmo.onsofprona.on/supina.on

•  Instabilitycanoccuratthisar.cula.on

Page 32: Wrist and Hand Examinaon...Objecves • Understand the osseous, ligamentous, tendinous, and neural anatomy of the wrist and hand • Outline palpable superficial landmarks in the

DorsalWrist

•  AnatomicsnuZox•  Dorsal-radialsideof

wrist

Page 33: Wrist and Hand Examinaon...Objecves • Understand the osseous, ligamentous, tendinous, and neural anatomy of the wrist and hand • Outline palpable superficial landmarks in the

DorsalWrist

•  AnatomicsnuZox•  Boundedby:•  Radially-1st

dorsalwristcompartmenttendons•  Abdpollicus

longus,Extpollicisbrevis

Page 34: Wrist and Hand Examinaon...Objecves • Understand the osseous, ligamentous, tendinous, and neural anatomy of the wrist and hand • Outline palpable superficial landmarks in the

DorsalWrist

•  AnatomicsnuZox•  Boundedby:•  Ulnarly-3rddorsal

wristcompartmenttendon•  Extpollicis

longus

Page 35: Wrist and Hand Examinaon...Objecves • Understand the osseous, ligamentous, tendinous, and neural anatomy of the wrist and hand • Outline palpable superficial landmarks in the

DorsalWrist

•  AnatomicsnuZox•  Boundedby:•  Proximal–Radial

styloid

Page 36: Wrist and Hand Examinaon...Objecves • Understand the osseous, ligamentous, tendinous, and neural anatomy of the wrist and hand • Outline palpable superficial landmarks in the

DorsalWrist

•  AnatomicsnuZox•  Boundedby:•  Distal–1st

metacarpalhead

Page 37: Wrist and Hand Examinaon...Objecves • Understand the osseous, ligamentous, tendinous, and neural anatomy of the wrist and hand • Outline palpable superficial landmarks in the

DorsalWrist

•  AnatomicsnuZox•  Palpabledeepin

dorsalsnuZox•  Scaphoid•  Radialartery•  Superficialradial

nerve

Page 38: Wrist and Hand Examinaon...Objecves • Understand the osseous, ligamentous, tendinous, and neural anatomy of the wrist and hand • Outline palpable superficial landmarks in the

DorsalWrist

•  Lister’sTubercle•  Bonyprominenceon

dorsalsurfaceofdistalradiusjustproximaltoradiocarpalar.cula.on

Page 39: Wrist and Hand Examinaon...Objecves • Understand the osseous, ligamentous, tendinous, and neural anatomy of the wrist and hand • Outline palpable superficial landmarks in the

DorsalWrist

•  Lister’sTubercle•  Extensorpollicis

longuscurvesaroundthistuberclefromdistalforearmtoulnarthumb

Page 40: Wrist and Hand Examinaon...Objecves • Understand the osseous, ligamentous, tendinous, and neural anatomy of the wrist and hand • Outline palpable superficial landmarks in the

DorsalWristCompartments

•  1st–AbductorPollicisLongus,ExtensorPollicisBrevis•  2nd–ExtensorCarpiRadialisLongusandBrevis•  3rd–ExtensorPollicisLongus•  4th–ExtensorIndicisProprius,ExtensorDigitorum•  5th–ExtensorDigi.Minimi•  6th–ExtensorCarpiUlnaris

Page 41: Wrist and Hand Examinaon...Objecves • Understand the osseous, ligamentous, tendinous, and neural anatomy of the wrist and hand • Outline palpable superficial landmarks in the

DorsalWristCompartments

•  1st–AbductorPollicisLongus,ExtensorPollicisBrevis

•  DeQuervain’sTenosynovi.s

Page 42: Wrist and Hand Examinaon...Objecves • Understand the osseous, ligamentous, tendinous, and neural anatomy of the wrist and hand • Outline palpable superficial landmarks in the

PalmarWristTendons

•  Brachioradialis•  Flexorcarpiradialis•  Flexorpollicislongus•  Flexordigitorum

profundusandsuperficialis

•  Palmarislongus•  Flexorcarpiulnaris

Page 43: Wrist and Hand Examinaon...Objecves • Understand the osseous, ligamentous, tendinous, and neural anatomy of the wrist and hand • Outline palpable superficial landmarks in the

PalmarWristTendons

•  Brachioradialis•  Flexorcarpiradialis•  Flexorpollicislongus•  Flexordigitorum

profundusandsuperficialis

•  Palmarislongus•  Flexorcarpiulnaris

Page 44: Wrist and Hand Examinaon...Objecves • Understand the osseous, ligamentous, tendinous, and neural anatomy of the wrist and hand • Outline palpable superficial landmarks in the

PalmarWristTendons

•  Brachioradialis•  Flexorcarpiradialis•  Flexorpollicislongus•  Flexordigitorum

profundusandsuperficialis

•  Palmarislongus•  Flexorcarpiulnaris

Page 45: Wrist and Hand Examinaon...Objecves • Understand the osseous, ligamentous, tendinous, and neural anatomy of the wrist and hand • Outline palpable superficial landmarks in the

PalmarWristTendons

•  Brachioradialis•  Flexorcarpiradialis•  Flexorpollicislongus•  Flexordigitorum

profundusandsuperficialis

•  Palmarislongus•  Flexorcarpiulnaris

Page 46: Wrist and Hand Examinaon...Objecves • Understand the osseous, ligamentous, tendinous, and neural anatomy of the wrist and hand • Outline palpable superficial landmarks in the

PalmarWristTendons

•  Brachioradialis•  Flexorcarpiradialis•  Flexorpollicislongus•  Flexordigitorum

profundusandsuperficialis

•  Palmarislongus•  Flexorcarpiulnaris

Page 47: Wrist and Hand Examinaon...Objecves • Understand the osseous, ligamentous, tendinous, and neural anatomy of the wrist and hand • Outline palpable superficial landmarks in the

PalmarWristTendons

•  Brachioradialis•  Flexorcarpiradialis•  Flexorpollicislongus•  Flexordigitorum

profundusandsuperficialis

•  Palmarislongus•  Flexorcarpiulnaris

Page 48: Wrist and Hand Examinaon...Objecves • Understand the osseous, ligamentous, tendinous, and neural anatomy of the wrist and hand • Outline palpable superficial landmarks in the

PalmarWristTendons

•  Brachioradialis•  Flexorcarpiradialis•  Flexorpollicislongus•  Flexordigitorum

profundusandsuperficialis

•  Palmarislongus•  Flexorcarpiulnaris

Page 49: Wrist and Hand Examinaon...Objecves • Understand the osseous, ligamentous, tendinous, and neural anatomy of the wrist and hand • Outline palpable superficial landmarks in the

Hand

•  Metacarpal-PhalangealJoints(MCPs)

Page 50: Wrist and Hand Examinaon...Objecves • Understand the osseous, ligamentous, tendinous, and neural anatomy of the wrist and hand • Outline palpable superficial landmarks in the

Hand

•  ProximalInter-PhalangealJoints(PIPs)

Page 51: Wrist and Hand Examinaon...Objecves • Understand the osseous, ligamentous, tendinous, and neural anatomy of the wrist and hand • Outline palpable superficial landmarks in the

Hand

•  DistalInter-PhalangealJoints(DIPs)

Page 52: Wrist and Hand Examinaon...Objecves • Understand the osseous, ligamentous, tendinous, and neural anatomy of the wrist and hand • Outline palpable superficial landmarks in the

RangeofMo.on

•  Wrist•  Flexionto90•  Extensionto60•  Ulnardevia.onto45

Page 53: Wrist and Hand Examinaon...Objecves • Understand the osseous, ligamentous, tendinous, and neural anatomy of the wrist and hand • Outline palpable superficial landmarks in the

RangeofMo.on

•  Fingers•  Allfingersshouldachievefullflexionandextension

•  Lag–lackofACTIVErangeofmo.on•  Block–lackofPASSIVErangeofmo.on

Page 54: Wrist and Hand Examinaon...Objecves • Understand the osseous, ligamentous, tendinous, and neural anatomy of the wrist and hand • Outline palpable superficial landmarks in the

NeurologicExamina.on

•  MedianNerve

•  UlnarNerve

•  RadialNerve

Page 55: Wrist and Hand Examinaon...Objecves • Understand the osseous, ligamentous, tendinous, and neural anatomy of the wrist and hand • Outline palpable superficial landmarks in the

NeurologicExamina.on

•  MedianNerve•  Loca.on•  Enterswristdeep

tothetransversecarpalligamentwithinthecarpaltunnel

Page 56: Wrist and Hand Examinaon...Objecves • Understand the osseous, ligamentous, tendinous, and neural anatomy of the wrist and hand • Outline palpable superficial landmarks in the

NeurologicExamina.on

•  MedianNerve•  Innervates•  Flexordigitorumprofundusandsuperficialis•  Flexorpollicislongus•  Pronatorquadratus•  Pronatorteres•  Flexorcarpiradialis•  Abductorpollicisbrevis

Page 57: Wrist and Hand Examinaon...Objecves • Understand the osseous, ligamentous, tendinous, and neural anatomy of the wrist and hand • Outline palpable superficial landmarks in the

NeurologicExamina.on

•  MedianNerve•  Cutaneoussensa.on•  Thenareminence•  Palmaraspectof

radial3½fingers•  Distaldorsal

aspectofradial3½

Page 58: Wrist and Hand Examinaon...Objecves • Understand the osseous, ligamentous, tendinous, and neural anatomy of the wrist and hand • Outline palpable superficial landmarks in the

NeurologicExamina.on

•  UlnarNerve•  Loca.on•  Traversesthrough

Guyon’scanalatwrist•  Justradialto

pisiform•  Liesbetween

pisiformandhookofhamate

Page 59: Wrist and Hand Examinaon...Objecves • Understand the osseous, ligamentous, tendinous, and neural anatomy of the wrist and hand • Outline palpable superficial landmarks in the

NeurologicExamina.on

•  UlnarNerve•  Innervates•  FDPandFDStoringandliTlefingers•  Firstdorsalinterosseus•  Abductordigi.minimi

Page 60: Wrist and Hand Examinaon...Objecves • Understand the osseous, ligamentous, tendinous, and neural anatomy of the wrist and hand • Outline palpable superficial landmarks in the

NeurologicExamina.on

•  UlnarNerve•  Cutaneous

innerva.on•  Ulnar1½digit

palmaranddorsalsurfaces

•  Hypotenareminence

Page 61: Wrist and Hand Examinaon...Objecves • Understand the osseous, ligamentous, tendinous, and neural anatomy of the wrist and hand • Outline palpable superficial landmarks in the

NeurologicExamina.on

•  RadialNerve•  Loca.on•  Throughspiralgrooveatmid-humerus•  Betweentwoheadsofsupinator(ulnar,humeral)•  Dorsalforearmdivisions•  Deepmotorbranch•  Becomesposteriorinterosseousnerve

•  Superficialsensorybranch•  Crosseswristatdorsolateralradius

Page 62: Wrist and Hand Examinaon...Objecves • Understand the osseous, ligamentous, tendinous, and neural anatomy of the wrist and hand • Outline palpable superficial landmarks in the

NeurologicExamina.on

•  RadialNerve•  Innervates•  Extensorsofwrist,thumb,anddigits•  Supinator

Page 63: Wrist and Hand Examinaon...Objecves • Understand the osseous, ligamentous, tendinous, and neural anatomy of the wrist and hand • Outline palpable superficial landmarks in the

NeurologicExamina.on

•  RadialNerve•  Cutaneous

innerva.on•  Dorsalwristand

hand•  Dorsalradial3½

fingerstoDIPjoints

Page 64: Wrist and Hand Examinaon...Objecves • Understand the osseous, ligamentous, tendinous, and neural anatomy of the wrist and hand • Outline palpable superficial landmarks in the

NeurologicExamina.on

•  RadialNerve•  Dorsalforearm

divisions•  Deepmotor

branch•  Becomes

posteriorinterosseousnerve

Page 65: Wrist and Hand Examinaon...Objecves • Understand the osseous, ligamentous, tendinous, and neural anatomy of the wrist and hand • Outline palpable superficial landmarks in the

NeurologicExamina.on

•  RadialNerve•  Dorsalforearm

divisions•  Superficialsensory

branch•  Crosseswrist

atdorsolateralradius

Page 66: Wrist and Hand Examinaon...Objecves • Understand the osseous, ligamentous, tendinous, and neural anatomy of the wrist and hand • Outline palpable superficial landmarks in the

Provoca.veTes.ng

•  ATempttoreproduceforce/mechanismofinjurywithmanualtes.ng

•  Performonlyalerrulingoutfracture

Page 67: Wrist and Hand Examinaon...Objecves • Understand the osseous, ligamentous, tendinous, and neural anatomy of the wrist and hand • Outline palpable superficial landmarks in the

WatsonTest

•  Assessesforscapholunateinstability•  akaScaphoidShilTest

•  Procedure•  Placethumboverscaphoidtubercleandindexfinger

overdorsalaspectofscapholunatejoint•  Applydorsallydirectedforcewiththumbagainst

distalpoleofscaphoidwhilepassivelymovingwristfromulnartoradialdevia.on

Page 68: Wrist and Hand Examinaon...Objecves • Understand the osseous, ligamentous, tendinous, and neural anatomy of the wrist and hand • Outline palpable superficial landmarks in the

WatsonTest

•  Posi.veTest•  Sudden,dyskine.cshilofscaphoidwithdorsal

wristpain•  “Catch-upClunk”

•  Pathoanatomy•  Instabilityatthescapholunatejointinterferes

withnormalflexion-extensionmo.onofthescaphoidduringwristradial-ulnardevia.on

Page 69: Wrist and Hand Examinaon...Objecves • Understand the osseous, ligamentous, tendinous, and neural anatomy of the wrist and hand • Outline palpable superficial landmarks in the

LunotriquetralShuck/Shear

•  Assessesforlunotriquetralinstability

•  Procedure•  Grasplunatebetweenthethumbandindexfinger

ofonehand•  Grasptriquetrum/pisiformbetweenthethumband

indexfingerofsecondhand•  Shilthetwograspinghandsinoppositedirec.ons

Page 70: Wrist and Hand Examinaon...Objecves • Understand the osseous, ligamentous, tendinous, and neural anatomy of the wrist and hand • Outline palpable superficial landmarks in the

LunotriquetralShuck/Shear

•  Posi.veTest•  Reproduc.onofpain•  Lunotriquetralexcursiongreaterthan2mm

•  Pathoanatomy•  Instability/ligamentousinsufficiencyat

lunotriquetralar.cula.on

Page 71: Wrist and Hand Examinaon...Objecves • Understand the osseous, ligamentous, tendinous, and neural anatomy of the wrist and hand • Outline palpable superficial landmarks in the

DistalRadioulnarJointInstability

•  Assessesfordorsal-volarinstability

•  Procedure•  Graspdistalradiusandulnabetweenthumband

indexofoppositehands3-4cmproximaltowrist•  Translateradiusrela.vetoulnainneutral,

supina.on,andprona.on

Page 72: Wrist and Hand Examinaon...Objecves • Understand the osseous, ligamentous, tendinous, and neural anatomy of the wrist and hand • Outline palpable superficial landmarks in the

DistalRadioulnarJointInstability

•  Posi.vetest•  Crepitus•  Transla.on>5mm

Page 73: Wrist and Hand Examinaon...Objecves • Understand the osseous, ligamentous, tendinous, and neural anatomy of the wrist and hand • Outline palpable superficial landmarks in the

CarpalTunnelSyndrome

•  Provoca.veTests•  CarpalTunnelCompressionTest•  PhalenTest•  ReversePhalenTest•  TinelSign

Page 74: Wrist and Hand Examinaon...Objecves • Understand the osseous, ligamentous, tendinous, and neural anatomy of the wrist and hand • Outline palpable superficial landmarks in the

CarpalTunnelSyndrome

•  CarpalTunnelCompressionTest•  Procedure•  Applyfirmpressuredirectlytocarpaltunnel•  Betweenscaphoidandpisiform•  Distaltowristcrease

•  Havepa.entlightlymakefist

Page 75: Wrist and Hand Examinaon...Objecves • Understand the osseous, ligamentous, tendinous, and neural anatomy of the wrist and hand • Outline palpable superficial landmarks in the

CarpalTunnelSyndrome

•  CarpalTunnelCompressionTest•  Posi.veTest•  Paresthesiasindistribu.onofmediannerve

Page 76: Wrist and Hand Examinaon...Objecves • Understand the osseous, ligamentous, tendinous, and neural anatomy of the wrist and hand • Outline palpable superficial landmarks in the

CarpalTunnelSyndrome

•  PhalenTest

•  Procedure•  Elbowsflexion,forearmneutral•  Wristinmaximalpassiveflexion

•  Posi.veTest•  Paresthesiasindistribu.onofmediannerve

Page 77: Wrist and Hand Examinaon...Objecves • Understand the osseous, ligamentous, tendinous, and neural anatomy of the wrist and hand • Outline palpable superficial landmarks in the

CarpalTunnelSyndrome

•  ReversePhalenTest

•  Procedure•  Elbowsflexion,forearmneutral•  Wristinmaximalpassiveextension

•  Posi.veTest•  Paresthesiasindistribu.onofmediannerve

Page 78: Wrist and Hand Examinaon...Objecves • Understand the osseous, ligamentous, tendinous, and neural anatomy of the wrist and hand • Outline palpable superficial landmarks in the

CarpalTunnelSyndrome

•  TinelSign•  Procedure•  Percussionovermediannervewithinthecarpal

tunnel•  Betweenscaphoidandpisiform•  Distaltowristcrease

•  Posi.veTest•  Paresthesiasindistribu.onofmediannerve

Page 79: Wrist and Hand Examinaon...Objecves • Understand the osseous, ligamentous, tendinous, and neural anatomy of the wrist and hand • Outline palpable superficial landmarks in the

FinkelsteinTest

•  Assessesfortenosynovi.sinvolvingthetendonsofthefirstdorsalwristcompartment(APLandEPB)

•  Procedure•  Wristinneutralposi.on•  Examinerplacesthumbondorsalthumb

proximalphalanxandfingersonpalmaraspecttograspthumb

•  Wristisulnarlydeviated•  Thumbisgraduallypulledintomaximalflexion

Page 80: Wrist and Hand Examinaon...Objecves • Understand the osseous, ligamentous, tendinous, and neural anatomy of the wrist and hand • Outline palpable superficial landmarks in the

FinkelsteinTest

•  Posi.veTest•  Painoverfirstdorsalwristcompartmentordorsal

thumb

•  Pearl•  Canalsocausepainsecondaryto1stCMCjointOA

Page 81: Wrist and Hand Examinaon...Objecves • Understand the osseous, ligamentous, tendinous, and neural anatomy of the wrist and hand • Outline palpable superficial landmarks in the

CarpometacarpalCompressionTest

•  Assessesfor1stCMCjointpathology,mostcommonlyarthri.s

•  AimistoproduceaxialcompressionofthethumbfirstCMCjointwitha“mortarandpestle”ac.on•  ElicitpainfromCMC/basalthumbosteoarthri.s

Page 82: Wrist and Hand Examinaon...Objecves • Understand the osseous, ligamentous, tendinous, and neural anatomy of the wrist and hand • Outline palpable superficial landmarks in the

CarpometacarpalCompressionTest

•  Procedure•  Grasppa.ent’s1stmetacarpalwithonehandand

thedistalradiuswiththeother•  Applyalongitudinalcompressionalongthe1st

metacarpalintothecarpalbone,axiallycompressingtheCMCjoint

•  Applyrotatorymo.ontometacarpal•  Posi.veTest•  Painat1stCMCjoint

Page 83: Wrist and Hand Examinaon...Objecves • Understand the osseous, ligamentous, tendinous, and neural anatomy of the wrist and hand • Outline palpable superficial landmarks in the

Froment’sSign

•  Assessesintrinsichandmusclestrength•  Posi.vetestindicatesweaknessofulnar-innervated

adductorpollicismuscle

•  Procedure•  Posi.onthumbagainstsecondfingerina“pinchgrip”

posi.on•  Pa.entisinstructedtoac.velyadductthumbinto2nd

fingertopinchfingerstogether

Page 84: Wrist and Hand Examinaon...Objecves • Understand the osseous, ligamentous, tendinous, and neural anatomy of the wrist and hand • Outline palpable superficial landmarks in the

Froment’sSign

•  Posi.veTest•  ProminentflexionatthumbIPjointbecauseof

insufficientadduc.onstrength•  MedianinnervatedFPLintactandflexesFPLof

thethumbtocompensateandmaintainpinchpressure

Page 85: Wrist and Hand Examinaon...Objecves • Understand the osseous, ligamentous, tendinous, and neural anatomy of the wrist and hand • Outline palpable superficial landmarks in the

Gamekeeper’sThumb

•  AssessesforthumbMCPjointUlnarCollateralLigamentinsufficiency/laxity

•  Procedure•  Immobilizethumbmetacarpalinwithonehandand

theproximalphalanxwiththeother•  Applyanulnarlydirectedforcetotheradialsideof

thejointtogapthethumbMCPjointonulnarside

Page 86: Wrist and Hand Examinaon...Objecves • Understand the osseous, ligamentous, tendinous, and neural anatomy of the wrist and hand • Outline palpable superficial landmarks in the

Gamekeeper’sThumb

•  Posi.veTest•  PainatthumbMCPjoint•  Asymmetricgappingofradialsideofjoint

Page 87: Wrist and Hand Examinaon...Objecves • Understand the osseous, ligamentous, tendinous, and neural anatomy of the wrist and hand • Outline palpable superficial landmarks in the

Ques.ons


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