Remember! Not all that clicks or clunks is abnormal most wrists don’t have ‘interesting’ instabilities investigation of the wrist is clinical - investigations add little knowledge of surface anatomy critical
Radial Side Styloid De Quervain’s - Finkelstein (JBJS 12A; 509, 1930) Wartenbergs Intersection
Radial Side Snuffbox swelling articular / non-articular pain –scaphoid #’s –impingement, (malunion) –scapho-styloid OA
Palmar Ulnar FCU tendonitis Piso-triquetral OA - compression Hook of Hamate - fist in UD hypothenar hammer syndrome Guyon’s canal compression pillar pain
Provocative Testing Scaphoid shift Finger extension test Midcarpal clunk L-T shuck test DRUJ –grind –pain at extremes
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’
Scaphoid shift - Watson’s test Qualitative assessment of scaphoid instability 10% normal wrists have positive test - take care!
Finger extension test Resisted finger extension in full passive wrist flexion +ve in DWS, SLAC, SLD, RSS, MCI, Kienbock’s