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Wrist Exam

Introduction

Greetings
Hand wash
Verify the patient's identity using at least two or three details
Explanation
Consent
Expose both upper limbs

Examination should include elbow, forearm, and hand

Ask if there's any pain and where
Confirm if patient is left or right handed

Look

Natural resting position
Scars
Asymmetry between sides
Swelling (diffuse v localised)

Feel

Warmth

Use back of hands, compare sides

Palpate for tenderness
Ulnar styloid

Lies more proximally than the radial styloid

Radial Styloid
Distal Radio-ulnar joint
Ulnocarpal joint
Radiocarpal joint
Scaphoid

In anatomical snuff box (EPL tendon ulnar border, AbdPL and EPB radial border, radial styloid proximal border)

Lunate

Bony prominence proximal to capitate sulcus

Hook of hamate

1cm distal and radial to pisiform

Pisiform

Flexor crease of the wrist on the ulnar side

Move

Active movements
Wrist extension

Normal 70°. ECRL, ECRB, ED, ECU. Check prayer position

Wrist flexion

Normal 80-90°. FCR, PL, FCU (primary); FDS, FDP, FPL (secondary). Check reverse prayer position

Supination

Supinator muscle

Pronation

Pronator teres, Pronator quadratus

Ulnar deviation

Normal 60°. ECU, FCU

Radial deviation

Normal 20°. ECRB, ECRL, FCR

Passive extension and flexion
Movement against resistance

Special tests

Passive loaded wrist extension

To provoke dorsal central wrist pathology

De Quervain's Tenosynovitis test

Tests AbdPL and EPB

Exam Progress

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