Physical examination of the wrist requires knowledge of wrist anatomy and pathology to make a diagnosis or narrow the differential diagnosis. Symptoms are provoked by palpation and signs are produced by manipulation. Negative findings elsewhere in the wrist are important. The final diagnosis may require diagnostic imaging.
Follows the IP-PASS examination methodology
- Inspection
- Palpation
- Passive Range of Motion
- Active Range of Motion
- Strength & Neurovascular
- Special Tests
Inspection
- Skin
- Color: erythema, ecchymosis, white, black
- Trophic changes (altered hair growth, sweat production)
- Scars
- Swelling
- Muscle tone
- Atrophy, hypertrophy
- Deformity: asymmetry, rotation, amputation
Palpation
- Joint Effusion
- Clicking
- Snapping
- Crepitus
- Tenderness
- Temperature
- Masses
Range of Motion
- Wrist
- Flexion: 80°-90°
- Extension: 60°-70°
- Radial Deviation: 15°-20°
- Ulnar Deviation: 40°-60°
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
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 Interosseous Nerve: Most hand and wrist extensors
- Vascular
- Radial pulse
- Ulnar pulse
- Allen’s Test
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
