WRIST EVALUATIONPart 2

Overview

Observation Examination

AROM/PROMSpecial testsNeurological examCirculatory exam

Observation

1. Overall position of person 2. Are they using the involved limb? 3. Is the wrist or hand in an abnormal

position? 4. Is the limb hanging limp? 5. Swelling 6. Skin color 7. Signs of trauma 8. Skin temperature

Observation

9. Deformities 10.Atrophy 11.Abnormalities 12.Compare 13.Carrying angle 14.Muscle spasm

Palpation

1. Navicular /scaphoid2. Lunate 3. Triquetrium 4. Pisiform5. Trapezium 6. Trapezoid 7. Capitate 8. Hamate

Palpation

9. Lister’s tubercle 10.Metacarpals 11.Phalanges 12.Thenar eminence

(base of thumb, palmar aspect)

13.Hypothenar eminence (little finger side, palmar aspect)

Palpation

14.Radius 15.Ulna 16.Radial styloid process 17.Ulnar styloid process 18.Metacarpo-phalangeal (MP) joints 19.Proximal Interphalangeal (PIP) joints 20.Distal Interphalangeal (DIP) joints

Palpation

21.Anatomical snuff box

22.Tunnel of Guyon 23.Carpal tunnel

Palpation: Soft Tissue

1. Median nerve 2. Ulnar nerve 3. Radial nerve 4. Transverse carpal ligament 5. Ulnar collateral ligament 6. Radial collateral ligament 7. Ulnar artery 8. Biceps brachii 9. Brachioradialis 10.Pronator teres 11.Pronator quadratus

Palpation: Soft Tissue

12.Supinator 13.Extensor carpi radialis longus 14.Extensor carpi radialis brevis 15.Extensor carpi ulnaris 16.Extensor digitorum 17.Extensor pollicis longus 18.Extensor pollicis brevis

Palpation: Soft Tissue

19.Flexor carpi radialis 20.Flexor carpi ulnaris 21.Flexor digitorum profundus 22.Flexor digitorum superficialis 23.Flexor pollicus longus 24.Flexor pollicis brevis 25.Abductor pollicus brevis 26.Adductor pollicus 27.Abductor digiti minimi 28.Palmar interossei 29.Palmaris longus

Examination

AROM/PROM Wrist:

1. Flexion 2. Extension 3. Circumduction 4. Radial deviation 5. Ulnar deviation 6. Supination 7. Pronation

Examination

AROM/PROM Fingers:

1. Flexion (each joint) 2. Extension (each joint) 3. Abduction (of each finger) 4. Adduction (of each finger) 5. Opposition (thumb and 5th finger) 6. Pinch (thumb and index finger)

Thumb: 1. Abduction 2. Adduction 3. 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