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Transcript
Examination of Hand
and Wrist
David Ahearne
Consultant Hand, Wrist and Shoulder
Surgeon
Look




Dorsum, side, palmar- palmar flex wrist to
exacerbate dorsal swellings
Deformity e.g. radial deviation after colles,
prominent ulna
Swellings e.g. ganglion
Scars, muscle wasting
Feel


Start radial side & move in a circle around wrist;
Palpate for tenderness of :
- APL, EPL- de Quervain's
- Anatomical snuffbox- scaphoid
- Distal Radioulnar joint
- lunate- locate by dorsiflexing wrist
- ulnar styloid
- Hook of hamate
- Pisiform- pisiform triquetral degen
- Guyons canal
- Over median nerve
Surface Anatomy
Wrist

Functional ROM
Flexion 75
 Extension 75
 Radial Deviation 25
 Ulnar Deviation 45
 Pronation 60
 Supination 60

Ulnar Sided Wrist
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
DRUJ
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Piano key sign- for instability

ballottement of ulnar head, (prominence of ulna)
TFCC
shake hands with patient; ulnar deviate wrist whilst
rotating the forearm.
 Pain = positive.

Radial Sided Wrist Pain

De Quervain's tenosynovitis
Finkelstein's test
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Thumb CMC joint
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Press over CMC joint
circumduct thumb with axial pressure
STT joint


ulnar deviation,
thumb not in palm
Resisted pronation causes pain
Wartenburg's (superficial radial nerve irritation)

Tinel's test
Carpal Tunnel Syndrome

Phalen's


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Elbows on the table allowing the wrists to passively flex. If
symptoms provoked within 60 secs then positive
61% sensitivity, 83% specificity
Tinel Test



Tapping lightly over the nerve reproduces symptoms in the
nerve’s sensory distribution.
Always assess from distal to proximal.
74% sensitivity, 91 % specificity
Ulnar Nerve Signs

Sensation
Normal over dorsal ulnar aspect of hand
 Entrapment below wrist


Motor

Weakness of 1st Dorsal Interrosei


Weakness of abduction of index finger
Weakness of Abductor digiti minimi
Questions