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Wrist Examination. S.Fallatah A.Giachino April 24/02. The key to correct examination of the wrist is precise location of the symptoms relating to the underlying anatomical structures.

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wrist examination

Wrist Examination



April 24/02

The key to correct examination of the wrist is precise location of the symptoms relating to the underlying anatomical structures.
  • A beauty of wrist examination is that almost all bony, articular, tendinous or vascular structures may be palpated through the overlying skin
  • Palpation
  • Range of motion
  • Special tests
  • Bilateral comparison
  • Observe the hand in function
  • Swelling
  • Rash
  • Deformity
  • Scars
  • Color and condition of nails
  • The contour of both palmer and dorsal surfaces
  • Skin palpation
    • The skin of both the palm and the palmer surface of the fingers is much thicker than that of the dorsal surface
    • The skin of the fingers is fixed to bone by septa and small ligaments
    • Check for any unusually worm or dry areas
    • Particular attention to any lesions
bony palpation
Bony palpation
  • Start by palpating the radial and ulnar styloid processes(the basic reference points of the carpal region)
  • Bones of the wrist
Radial styloid process…truly lateral
  • Anatomic snuffbox..distal and slightly dorsal to the radial styloid process,becomes outlined&palpable when the patient extends his thumb
  • Scaphoid(Navicular)..the floor of the snuffbox,palpable on ulnar deviation of the wrist
  • Trapezium/1st metacarpal articulation
Lister’s tubercle..1/3 of the way across the dorsum of the wrist from the radial styloid process
  • Capitate..the largest of all the carpal bones
  • Lunate
  • The lunate,capitate,and the base of the 3rd metacarpal are in line with each other
Ulnar styloid process
  • Triquetrium..with radial deviation of the wrist
  • Pisiform
  • Hook of the Hamate
  • Metacarpals
  • Metacarpophalangeal joints
  • Phalanges
soft tissue palpation
Soft tissue palpation
  • Clinical zones of the wrist and the hands
  • Six extensor compartments(tunnels) and two flexors compartments.
  • Zone I : Radial styloid process
    • anatomicsnuffbox,1st extensor compartement
  • Zone II:Lister’s tubercle
    • 2nd,3rd, and 4th extensors compartements
  • Zone III: Ulnar styloid process
    • 5th and 6th compartements
  • Zone IV: Pisiform(palmar aspect)
    • FCU,Tunnel of Guyon,and ulnar artery
  • Zone V:
    • palmaris longus,carpal tunnel,and FCR
  • Zone I: Thenar eminence
    • APB,OP,FPB
  • Zone II: Hypothenar eminence
    • ADQ,OD,FDQ
  • Zone III: Palm
    • Palmar aponeurosis& fingers flexor tendons
  • Zone IV: Dorsum
    • Extensor tendons
  • Zone V: Phalages
  • Zone VI : Tufts of the fingers