Comprehensive wrist examination including DRUJ, carpal instability, TFCC assessment, and evaluation of common conditions like scaphoid injury and carpal tunnel syndrome.
The wrist examination requires systematic assessment of both carpal bones and the DRUJ. Key conditions include scaphoid fractures, scapholunate instability, TFCC injuries, and Kienbock's disease.
High-Yield Exam Summary
Patient Positioning: Seated opposite examiner with forearm resting on table or pillow
Exposure: Both forearms exposed from elbow to fingertips
Consent Script: "I'm going to examine your wrists. I'll look at both, feel around the joints, and test the movements. Please let me know if anything is painful."
Key Anatomy:
Dorsal Structures (Radial to Ulnar):
Volar Structures:
Special Palpation:
| movement | normalRange | technique | keyPoints |
|---|---|---|---|
| Flexion | 0-80° | Prayer position, lower hands | Compare symmetry |
| Extension | 0-70° | Reverse prayer, raise hands | Limited in dorsal ganglion |
| Radial Deviation | 0-20° | Wrist flat, move thumb toward radius | Less than ulnar deviation |
| Ulnar Deviation | 0-30° | Wrist flat, move hand to ulnar side | Pain in TFCC injury |
| Pronation | 0-80° | Elbow at 90°, palm down | DRUJ function |
| Supination | 0-80° | Elbow at 90°, palm up | DRUJ function |
Functional Wrist ROM: Most activities require 40° flexion, 40° extension (dart-thrower's arc through radial extension to ulnar flexion is most functional).
Scapholunate instability
Painful clunk as scaphoid subluxates dorsally, reduced pain when pressure released
Scapholunate ligament injury, scapholunate instability
Ability to detect true positives
Ability to exclude false positives
Scaphoid fracture
Point tenderness in anatomical snuffbox
Scaphoid fracture until proven otherwise
Ability to detect true positives
Ability to exclude false positives
Scaphoid fracture
Pain in scaphoid region
Scaphoid fracture
Ability to detect true positives
Ability to exclude false positives
DRUJ instability
Increased AP translation compared to other side, painful clunk
DRUJ instability, TFCC injury
Ability to detect true positives
Ability to exclude false positives
TFCC injury
Exquisite tenderness in fovea
TFCC tear (foveal insertion)
Ability to detect true positives
Ability to exclude false positives
TFCC pathology
Ulnar-sided wrist pain on loading
TFCC injury, ulnocarpal impaction
Ability to detect true positives
Ability to exclude false positives
de Quervain's tenosynovitis
Pain over first dorsal compartment (radial styloid area)
de Quervain's tenosynovitis (APL, EPB)
Ability to detect true positives
Ability to exclude false positives
Carpal tunnel syndrome
Paraesthesia in median nerve distribution (thumb, index, middle, radial half ring finger)
Carpal tunnel syndrome
Ability to detect true positives
Ability to exclude false positives
Carpal tunnel syndrome
Tingling or electric sensation radiating into median nerve distribution
Carpal tunnel syndrome
Ability to detect true positives
Ability to exclude false positives
Carpal tunnel syndrome
Reproduction of median nerve symptoms
Carpal tunnel syndrome
Ability to detect true positives
Ability to exclude false positives
Median Nerve:
Ulnar Nerve:
Radial Nerve:
Always state to the examiner:
"To complete my examination, I would like to:
"28-year-old male with radial wrist pain after falling onto outstretched hand 2 weeks ago."
| condition | look | feel | move | specialTests |
|---|---|---|---|---|
| Scaphoid Fracture | Snuffbox swelling | Snuffbox + tubercle tender | Painful grip | Compression test + |
| Scapholunate Instability | May be normal | SL interval tenderness | Weak grip | Watson shift + |
| TFCC Injury | Ulnar swelling | Fovea tenderness | Pain at end rotation | Piano key +, Press test + |
| de Quervain's | 1st compartment swelling | Radial styloid tender | Pain on thumb movement | Finkelstein's + |
| Carpal Tunnel Syndrome | Thenar wasting late | Normal bones | Normal ROM | Phalen's +, Durkan's + |
High-Yield Exam Summary