1 / 17

Examination of the Wrist

HAND SURGERY REVISION COURSE - QMC Nottingham. Examination of the Wrist. Mr P R Stuart FRCS Freeman Hospital Newcastle upon Tyne. OR. (‘clunk, click every trip’). Remember!. Not all that clicks or clunks is abnormal most wrists don’t have ‘interesting’ instabilities

ulf
Download Presentation

Examination of the Wrist

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


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

  2. OR (‘clunk, click every trip’)

  3. 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

  4. Radial Side Styloid • De Quervain’s - 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 • Lister’s tubercle -> 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 • Guyon’s 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 - Watson’s 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, Kienbock’s

  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

More Related