Clinical examination of wrist and hand (orthopedics posting) I do not own this file. Courtesy to Dr Madhusudhan, BBH Orthopaedics

1.
Page1
EXAMINATION OF WRIST AND HAND
CHIEF COMPLAINTS; - Pain , Deformity , Abnormal swellings.(say swelling only in
exostoses, GCT,)
History of presenting illness;- Elaborate on chief complaints, pain , swelling (onset,
duration etc)
ADL; - Inability to comb hair,(loss of pronation),not able to do namaste (dorsiflexion loss),
inability to write(stiffness), opening key,
NEGATIVE HISTORY;- H/O fall ( colles), midcarpal pain (instability , keinbocks disease
), symptoms of median nerve compression,Attritional ruptures of tendon(RA), DRUJ
subluxation(pain in TFCC), constitutional symptoms in TB(wrist)malignancy, early morning
stiffness in RA,
LOCAL EXAMINATION;-
ATTITUDE AND DEFORMITY ;- In colles- Dinner fork deformity, madelung deformity,
VIC flexion contracture of wrist, loss of finger cascade in metacarpal injuries swan neck
deformity, boutinerres deformity .
INSPECTION; -
Antrly; look for fullness in the L/E radius or wrist joint ,
level of radial and ulnar styloid process, use word swelling in exostoses or GCT( then you
should mention size, shape , surface , borders, etc) otherwise use word fullness in L/E radius
in case of fractures RA,
loss of knuckles (in mc #s) ,
loss of finger cascade(in phalanx #s , mc #s ,wasting of forearm muscles, interossei, ulnar
deviation of fingers (RA), taut extensor tendons ,visible scars or sinuses .
Side ;- inspect from both radial and ulnar side s ,appreciate for angular deformity – means
dorsal or volar angulation in lower end radius ,prominence of ulnar styloid process,
Palmar aspect; - appreciate fullness or swelling in the wrist join(eg in TB synovitis)look for
wasting of forearm, thenar and hypothenar muscles .
PALPATION;-
Superficial; - local rise in temparture, tenderness, hyper or hypoesthesia .
Deep palpation;-look for thickened synovium, look for tendon ruptures–
APL,EPB,EDL,FDP,FDS,ECRB,FCR,PL.

2.
Page2
Bony palpation;-
Palpate lower end radius and ulna , look for the following findings –
angulation,displacement(dorsal , lateral ), irregularity, broadening, thickening, Crepitus , step
sign (step up sign –colles#, stepdown sign –smiths#)
Joint line palpation;- pass finger along the lowerend radius the first depression u see is joint
line , look for tenderness (RA, keinbocks , I/A #s)
Relative position of two styloid process and DRUJ subluxation (do piano sign).
Palpation of carpal bones- scaphoid , lunate, etc
Palpation of metacarpals, phalanges,
MOVEMENTS :- check for the movements and also note-is it painful, Crepitus,l oss of
movement, lag, critical arc.
Palmar flexion 0-90deg FCR, FCU MEDIAN
NERV
FDP,FDS(ASSIST)
Dorsiflexion 0-80 deg ECRL, ECRB, RADIAL EDC,EI
Ulnar deviation 25-35 deg FCU ULNAR
Radial
deviation
15-25 deg FCR,ECRB MEDIAN,RADI APL,EPB
Pronation 0-90 deg PRO,TERES,
QUAD
ANTR
INTEROSS
NER
Supination 0-90 deg BICEPS,SUPIN C5-C6
MEASUREMENTS ;- Linear and circumferential .
Linear;- forearm- tip of lateral epicondyle to tip of radial styloid by convention
Circumferential – take a fixed mark from a bony point where there is maximum bulk of
muscle ,and take circumference of the FA to check for wasting.
DEFORMITY ASSESMENT :- look for Dorsal angulation and radial deviation
NEUROVASCULAR AND LYMPHATIC EXAMINATION;- Look for distal pulses,
radial , ulnar, and the nerves, and regional lymph node examination.
SPECIAL TESTS;-
Phalens and reverse phalens test for CTS.
Grind test;- for MCP &IP (trapeziometacarpal arthritis)
Finkelsteinn test- for De quervians .
DRUJ instability;- piano key sign and DRUJ compression test .
Carpal instability –Scapholunate instability- Watson shift test,scapholunate ballotment.
Linotrequitral instability-Ballotment test /reagen test.
DIAGNOSIS;-ANATOMICAL- which part is involved joint, metacarpal, phalanx,carpal
bones
PATHOLOGICAL- synovitis, arthritis, dislocation,instability, malunion .
INVESTIGATIONS;-
LABORATORY – Hb,Wbc, TcDc,ESR,CRP
RADIOLOGICAL –plain x ray of wrist AP & Lat, hand x ray-AP & Oblique
SPECIAL INVESTIGATION-MRI-in carpal instability.

3.
Page3
SELF NOTES