Wrist examination
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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

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Wrist examination

Wrist Examination

S.Fallatah

A.Giachino

April 24/02


Wrist examination

  • 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


Wrist examination

  • Positioning

  • Palpation

  • Range of motion

  • Special tests

  • Bilateral comparison


Inspection

Inspection

  • Observe the hand in function

  • Swelling

  • Rash

  • Deformity

  • Scars

  • Color and condition of nails

  • The contour of both palmer and dorsal surfaces


Palpation

Palpation

  • 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


Wrist examination

  • 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


Wrist examination

  • 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


Wrist examination

  • 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.


Wrist

wrist

  • 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


Wrist examination

Hand

  • 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


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