Part 2 Wrist Evaluation

Overview Observation Examination AROM/PROM Special tests Neurological exam Circulatory exam

Observation Overall position of person Are they using the involved limb? Is the wrist or hand in an abnormal position? Is the limb hanging limp? Swelling Skin color Signs of trauma Skin temperature

Observation Deformities Atrophy Abnormalities Compare Carrying angle Muscle spasm

Palpation Navicular /scaphoid Lunate Triquetrium Pisiform Trapezium Trapezoid Capitate Hamate

Palpation Lister’s tubercle Metacarpals Phalanges Thenar eminence (base of thumb, palmar aspect) Hypothenar eminence (little finger side, palmar aspect)

Palpation Radius Ulna Radial styloid process Ulnar styloid process Metacarpo-phalangeal (MP) joints Proximal Interphalangeal (PIP) joints Distal Interphalangeal (DIP) joints

Palpation Anatomical snuff box Tunnel of Guyon Carpal tunnel

Palpation: Soft Tissue Median nerve Ulnar nerve Radial nerve Transverse carpal ligament Ulnar collateral ligament Radial collateral ligament Ulnar artery Biceps brachii Brachioradialis Pronator teres Pronator quadratus

Palpation: Soft Tissue Supinator Extensor carpi radialis longus Extensor carpi radialis brevis Extensor carpi ulnaris Extensor digitorum Extensor pollicis longus Extensor pollicis brevis

Palpation: Soft Tissue Flexor carpi radialis Flexor carpi ulnaris Flexor digitorum profundus Flexor digitorum superficialis Flexor pollicus longus Flexor pollicis brevis Abductor pollicus brevis Adductor pollicus Abductor digiti minimi Palmar interossei Palmaris longus

Examination AROM/PROM Wrist: Flexion Extension Circumduction Radial deviation Ulnar deviation Supination Pronation

Examination AROM/PROM Fingers: Thumb: Flexion (each joint) Extension (each joint) Abduction (of each finger) Adduction (of each finger) Opposition (thumb and 5th finger) Pinch (thumb and index finger) Thumb: Abduction Adduction Circumduction  

Neurologic Exam: Sensory Sensory dermatomes C2-C3: Occipital area and angle of jaw C4: Supraclavicular area Axillary Nerve Patch: Lateral aspect of shoulder C5: Lateral upper arm C6: Lateral forearm, thumb, and index finger C7: Middle finger and palmar aspect of hand C8: Small finger, ring finger, and medial portion of palmar surface T1: Medial side of forearm and elbow T2: Medial aspect of upper arm T3: Medial aspect of upper arm

Neurologic Exam: Motor C1-C2: Neck flexion C1-C2: Neck extension C3: Neck lateral flexion C4: Shoulder elevation C5: Shoulder abduction and external rotation C6: Elbow flexion and wrist extension C7: Elbow extension and wrist flexion C8: Thumb abduction and ulnar deviation T1: Finger approximation

Neurologic Exam: Reflexes Biceps (C5-C6) Supinator (C5-C6) Triceps (C7-C8)

Circulatory Carotid Brachial Radial