Wrist And Hand Examination

Question 1

Observation

Answer 1

Skin - colour, brittleness, bruising, mail changes, hair changes, sweating
Swelling, tenosynovitis, scars
Joint deformity
Bone deformity
Ganglions
Muscle bulk - thenar, hypothenar, intrinsics

Question 2

Palpation

Answer 2

Temperature
Swelling
Muscle bulk
Pulses
Bony anatomy - carpals, metacarpals, phalanges
Tension anatomy - anatomical snuff box
Borders of carpal tunnel

Question 3

Active range of motion

Answer 3

Wrist - flexion and extension (pronation and supination), pronation, supination, ulnar and radial deviation
Hand - flexion and extension (of all Metacarpophalangeal and interphalangeal joints), abduction, adduction, make a fist, thum opposition to index to 5th digit

Question 4

Passive range of motion

Answer 4

Wrist - flexion and extension (pronation and supination), pronation, supination, ulnar and radial deviation
Hand - flexion and extension (of all Metacarpophalangeal and interphalangeal joints), abduction, adduction, make a fist, thum opposition to index to 5th digit

Question 5

Isometric

Answer 5

Wrist - flexion and extension (pronation and supination), pronation, supination, ulnar and radial deviation
Hand - flexion and extension (of all Metacarpophalangeal and interphalangeal joints), abduction, adduction, make a fist, thum opposition to index to 5th digit

Question 6

Tinel’s sign test

Answer 6

Tapping around the area of the carpal tunnel and nerves
Tingling or “pins and needles” may indicate there is nerve compression or damage

Question 7

Finkelstein’s test

Answer 7

Patient makes a fist around the thumb
Stabilise their forearm and ask them to ulnar deviate
Ask if there is any pain
Abductor pollicis longus

Question 8

Phalen’s test

Answer 8

Patient holds both wrists in complete and forced flexion
Pushing the dorsal surfaces of both hands together
30-60 seconds
Increases pressure in the carpal tunnel

Question 9

AP proximal radio-carpal joint

Answer 9

Patients forearm in supination and wrist rested on a pillow or towel
Place one had over the distal radius and ulnar
Other hand around the base of the hand
Push down over the proximal carnal bones

Question 10

PA proximal radio-carpal joint

Answer 10

Patients forearm in pronation and wrist rested on a pillow or towel
Place one had over the distal radius and ulnar
Other hand around the base of the hand
Push down over the proximal carnal bones

Question 11

AP/PA carpal bones

Answer 11

AP - supination
PA - pronation
Find each carpal bone and push down
The pisiform can be moved easier if the wrist is slightly flexed