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Clinical Examination of Injuries to the Wrist, Hand, and Fingers

Examination Map HISTORY

Past Medical History

Previous injury history

General medical health

History of the Present Condition

Location of pain

Mechanism of injury

Onset and severity of symptoms

Changes in activity

FUNCTIONAL ASSESSMENT

Daily or Athletic Tasks That Are Associated With Reproduction or Exacerbation of Symptoms

Throwing (if Indicated)

INSPECTION

General Inspection

Wrist and hand posture

Gross deformity

Palmar creases

Lacerations or scars

  • Russell's sign

Inspection of the Wrist and Hand

Continuity of the radius and ulna

Continuity of the carpals and metacarpals

Alignment of the MCP IP joints

Ganglion cyst

Inspection of the Thumb and Fingers

Skin and fingernails

Subungual hematoma

Felon

Paronychia

Alignment of fingernails

Muscle contour

Finger posture

Palpation

Palpation of the Palmar Wrist

Radius

Flexor carpi radialis

Palmaris longus

Carpal tunnel

Ulna

Flexor carpi ulnaris

Triangular fibrocartilage complex

Pisiform

Hamate

Palpation of the Dorsal Wrist

Ulna

Ulnar styloid process

Ulnar collateral ligament

Extensor carpi ulnaris

Lister's tubercle

Distal radius/styloid process

Radial collateral ligament

Scaphoid

Lunate

Triquetrum

Trapezium

Capitate

Trapezoid

Extensor carpi radialis brevis

Extensor carpi radialis longus

Palpation of the Hand

Thenar eminence

Central compartment

Hypothenar compartment

Metacarpals

MCP collateral ligaments

Phalanges

IP joint collateral ligaments

Thenar webspace

Extensor digitorum

Extensor pollicis longus

Abductor pollicis longus

Abductor pollicis brevis

JOINT AND MUSCLE FUNCTION ASSESSMENT

Wrist

Goniometry

Active Range of Motion

  • Flexion and extension

  • Radial and ulnar deviation

Manual Muscle Tests

  • Flexion and extension

  • Radial and ulnar deviation

Passive Range of Motion

  • Flexion and extension

  • Radial and ulnar deviation

Thumb

Goniometry

Active Range of Motion

  • Flexion and extension

  • Abduction and adduction

Manual Muscle Tests

  • Flexion and extension

  • Abduction and adduction

  • Opposition

Passive Range of Motion

  • Flexion and extension

  • Abduction and adduction

  • Opposition and reposition

Fingers

Goniometry

Active Range of Motion

  • Flexion and extension - MCP joints

  • Abduction and adduction - MCP joints

  • Flexion and extension - IP joints

Manual Muscle Tests

  • PIP flexion

  • Abduction and adduction - MCP joints

  • Flexion and extension

  • Grip dynamometry

Passive Range of Motion

  • Flexion and extension - MCP joints

  • Abduction and adduction - MCP joints

  • Flexion and extension of the IP joints

JOINT STABILITY TESTS

Stress Testing

Wrist

  • Radial collateral ligament

  • Ulnar collateral ligament

Finger (PIP and DIP)

  • Radial collateral ligament

  • Ulnar collateral ligament

Joint Play Assessment

Wrist

  • Radial glide

  • Ulnar glide

  • Dorsal glide

  • Palmar glide

Hand

  • Intercarpal glide

NEUROLOGICAL EXAMINATION

Upper Quarter Screen

Tinel's Sign

REGION-SPECIFIC PATHOLOGIES AND SELECTIVE TISSUE TESTS

Wrist Pathologies

Distal forearm fracture

  • Colles' fracture

  • Smith's fracture

Scaphoid fracture

  • Scaphoid compression test

Preiser's disease

Hamate fracture

Perilunate/lunate dislocation

  • Dissociative carpal instability

  • Kienböck's disease

Wrist sprains

  • Watson test

Triangular fibrocartilage complex injury

Carpal tunnel syndrome

  • Phalen's test

Hand Pathologies

Metacarpal fractures

Finger Pathologies

Collateral ligament injuries

Boutonnière deformity

  • Pseudoboutonnière deformity

Finger fractures

Tendon ruptures and avulsion fractures

Thumb Pathologies

De Quervain's disease

  • Finkelstein's test

Thumb sprains

MCP joint dislocations

Thumb fractures

FIGURE 14-1

Nerve distribution in the hand.

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