Wrist Exam

See Telemedicine
Perform observation (see below) and compare with opposite side
Perform Wrist Range of Motion as below
Patient palpates their own wrist for point of maximal tenderness
Patient may perform specific testing with coaching
1. Carpal Tunnel Syndrome (Phalen's Test, Tinel's Test)
2. De Quervain's Tenosynovitis (Finkelstein Test)

Locate depression between Pisiform and ulnar styloid
1. Tenderness distal to this point suggests TFCC Injury
Patient and examiner shaking hands
1. Patient tries to supinate or pronate wrist
2. Pain or decreased ROM suggests TFCC Injury

Images
Pisiform
1. Ulnar side of palm just proximal to palmar crease
2. Flexor carpi ulnaris inserts on Pisiform
  1. Identify by opposing thumb and fifth finger
3. Assess for tenderness at bony prominence
Hook of Hamate
1. Hypothenar wrist, 1 cm distal to flexor crease
2. Identification Method 1
  1. Start at Pisiform
  2. Move 1-2 finger breadths toward midline
3. Identification Method 2
  1. Start with examiners thumb IP on Pisiform
  2. Direct thumb toward Index finger
  3. Thumb fingertip will rest over Hamate
4. Flex wrist and hook of Hamate becomes prominent
5. Palmaris longus (if present) courses above Hamate
  1. Identify by opposing thumb and fifth finger
  2. Absent in 10% of patients
  3. Do not confuse with flexor carpi radialis
Scaphoid tubercle
1. Palpable at extensor carpi radialis at palmar crease
2. Press at rest to assess for tubercle Fracture
  1. See Scaphoid Fracture Signs
3. Press while moving from ulnar to radial deviation
  1. See Scaphoid Shift Test

Images
Anatomic Snuff box
1. Radial border
  1. Extensor pollicis brevis
  2. Abductor pollicis longus
2. Ulnar border
  1. Extensor pollicis longus
Scaphoid distal pole
1. Located at anatomic snuff box
2. More easily palpated with wrist in ulnar deviation
3. Scaphoid is the most commonly Fractured Carpal Bone
4. See Scaphoid Fracture Signs
Carpal Bones on radial side of wrist
1. Shuck Test evaluates for inflammation/instability
Triscaphe Joint
1. Thumb follows second finger proximally over dorsum
2. Thumb falls into triscaphe joint depression
Lister's Tubercle (Radial Tubercle)
1. Distal radius prominence on wrist dorsum
2. Palpate radius dorsum while patient flexes wrist
3. Lines up with Third Metacarpal
  1. Lister's Tubercle
  2. Lunate
  3. Capitate
  4. Third Metacarpal
Scapholunate joint or interval
1. Most common carpal dislocation
2. Scaphoid Shift Test evaluates scapholunate injury
3. Identification (1.5 cm distal to Lister's Tubercle)
  1. Examiners finger starts over Third Metacarpal
  2. Trace Third Metacarpal proximally over dorsum
  3. Examiner's finger falls into depression
  4. Depression represents scapholunate joint
Lunate
1. Second to Scaphoid as most common wrist Fracture
2. Identification
  1. Identify with patient flexing wrist
    1. Most prominent area on dorsum of flexed wrist
  2. Lunate sits on ulnar side of scapholunate joint or
  3. Follow Lister's tubercle distally to 3rd Metacarpal