1. Wrist Examination S.Fallatah A.Giachino April 24/02

2. 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

4. Positioning Palpation Range of motion Special tests Bilateral comparison

5. Inspection Observe the hand in function Swelling Rash Deformity Scars Color and condition of nails The contour of both palmer and dorsal surfaces

6. 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

7. Bony palpation Start by palpating the radial and ulnar styloid processes(the basic reference points of the carpal region) Bones of the wrist

8. 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/1 st metacarpal articulation

9. 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 3 rd metacarpal are in line with each other

10. Ulnar styloid process Triquetrium..with radial deviation of the wrist Pisiform Hook of the Hamate Metacarpals Metacarpophalangeal joints Phalanges

11. Soft tissue palpation Clinical zones of the wrist and the hands Six extensor compartments(tunnels) and two flexors compartments.

12. wrist Zone I : Radial styloid process – anatomic snuffbox,1 st extensor compartement Zone II:Lister’s tubercle – 2 nd,3 rd, and 4 th extensors compartements Zone III: Ulnar styloid process – 5 th and 6 th compartements Zone IV: Pisiform(palmar aspect) – FCU,Tunnel of Guyon,and ulnar artery Zone V: – palmaris longus,carpal tunnel,and FCR

13. 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