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Examination of the Wrist

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HAND SURGERY REVISION COURSE - QMC Nottingham Examination of the Wrist Mr P R Stuart FRCS Freeman Hospital Newcastle upon Tyne ( clunk, click every trip ) Remember! – PowerPoint PPT presentation

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Title: Examination of the Wrist


1
Examination of the Wrist
HAND SURGERY REVISION COURSE - QMC Nottingham
  • Mr P R Stuart FRCS
  • Freeman Hospital
  • Newcastle upon Tyne

2
(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

4
Radial Side
  • Styloid
  • De Quervains - Finkelstein
    (JBJS 12A
    509, 1930)
  • Wartenbergs
  • Intersection

5
Radial Side
  • Snuffbox
  • swelling
  • articular / non-articular pain
  • scaphoid s
  • impingement, (malunion)
  • scapho-styloid OA

6
Dorsal
  • Radial
  • Listers tubercle -gt SL interval
  • occult ganglia
  • instability
  • Lunate - Keinbocks

7
Dorsal
  • Central
  • Carpal boss
  • Extensor compartments
  • extensor manus brevis
  • tenosynovitis - moves with tendons
  • ganglia
  • PIN neuritis
  • lunate capitate s

8
Dorsal
  • Ulnar
  • DRUJ
  • compression, translation, piano key, dimple
  • TFC
  • Luno-triquetral, triquetro-hamate
  • Ulnar carpal impaction - pronation UD

9
Dorsal
  • Ulnar
  • ECU instability
  • supination, UD, flexion
  • 4th 5th CMC OA
  • Mid-carpal instability

10
Palmar
  • Radial
  • scaphoid - tuberosity s
  • STT - common, ganglia
  • 1st CMC
  • FCR tendonitis / trapezial ridge fractures
  • PCB neuroma

11
Palmar
  • Ulnar
  • FCU tendonitis
  • Piso-triquetral OA - compression
  • Hook of Hamate - fist in UD
  • hypothenar hammer syndrome
  • Guyons canal compression
  • pillar pain

12
Provocative Testing
  • Scaphoid shift
  • Finger extension test
  • Midcarpal clunk
  • L-T shuck test
  • DRUJ
  • grind
  • pain at extremes

13
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

14
Scaphoid shift - Watsons test
  • Qualitative assessment of scaphoid instability
  • 10 normal wrists have positive test - take care!

15
Finger extension test
  • Resisted finger extension in full passive wrist
    flexion
  • ve in DWS, SLAC, SLD, RSS, MCI, Kienbocks

16
Articular - nonarticular
  • Periscaphoid synovitis, SLAC, instability,
    non-union

17
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
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