Examination of the Wrist

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Examination of the Wrist
HAND SURGERY REVISION COURSE - QMC Nottingham

• Mr P R Stuart FRCS
• Freeman Hospital
• Newcastle upon Tyne

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(clunk, click every trip)
OR
3
Remember!

• Not all that clicks or clunks is abnormal
• most wrists dont have interesting
  instabilities
• investigation of the wrist is clinical -
  investigations add little
• knowledge of surface anatomy critical

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Radial Side

• Styloid
• De Quervains - Finkelstein
  (JBJS 12A
  509, 1930)
• Wartenbergs
• Intersection

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Radial Side

• Snuffbox
• swelling
• articular / non-articular pain
• scaphoid s
• impingement, (malunion)
• scapho-styloid OA

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Dorsal

• Radial
• Listers tubercle -gt SL interval
• occult ganglia
• instability
• Lunate - Keinbocks

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Dorsal

• Central
• Carpal boss
• Extensor compartments
• extensor manus brevis
• tenosynovitis - moves with tendons
• ganglia
• PIN neuritis
• lunate capitate s

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Dorsal

• Ulnar
• DRUJ
• compression, translation, piano key, dimple
• TFC
• Luno-triquetral, triquetro-hamate
• Ulnar carpal impaction - pronation UD

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Dorsal

• Ulnar
• ECU instability
• supination, UD, flexion
• 4th 5th CMC OA
• Mid-carpal instability

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Palmar

• Radial
• scaphoid - tuberosity s
• STT - common, ganglia
• 1st CMC
• FCR tendonitis / trapezial ridge fractures
• PCB neuroma

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Palmar

• Ulnar
• FCU tendonitis
• Piso-triquetral OA - compression
• Hook of Hamate - fist in UD
• hypothenar hammer syndrome
• Guyons canal compression
• pillar pain

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Provocative Testing

• Scaphoid shift
• Finger extension test
• Midcarpal clunk
• L-T shuck test
• DRUJ
• grind
• pain at extremes

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Lax, loose, wobbly or unstable

• Like the shoulder there is a range of normal
• most mid-carpal joints can be subluxed (pushed
  into VISI)
• most clunks and abnormal movements can only be
  considered pathological if they occur during
  normal use and / or are painful
• the lax wrist is often painful without being
  unstable

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Scaphoid shift - Watsons test

• Qualitative assessment of scaphoid instability
• 10 normal wrists have positive test - take care!
  

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Finger extension test

• Resisted finger extension in full passive wrist
  flexion
• ve in DWS, SLAC, SLD, RSS, MCI, Kienbocks

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Articular - nonarticular

• Periscaphoid synovitis, SLAC, instability,
  non-union

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Catch-up clunk

• Proximal row flicking suddenly from volar flexion
  to dorsiflexion
• normal smooth transition from one to other under
  influence of capsular and intracarpal ligaments