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What are the examinations of Wrist joint

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Wrist joint examination

I. ‘Look’ or ‘Inspection’ of wrist joint :

1. Attitude or Deformity :

To check this, we can find various deformities like :

  • Wrist drop – This can occur due to radial nerve palsy
  • Benett’s fracture – This is the abnormal prominence of 1st metacarpal on the lateral side
  • Claw hand – Due to ulnar nerve palsy
  • Malunited colles fracture – This is the abnormal prominence of the ulnar head

2. Swelling :

There are some common diseases which can cause of an abnormal swelling.

  • De quervain’s disease – This can occur due to Inflammation of the tendon sheath, which joins the muscle to the bone that is tendosynovitis.
  • Rheumatoid arthritis – This occurs due to any joint inflammation.
  • Bouchard’s nodule – This can be due to swelling over the proximal inter phalangeal joint.
  • Lunate dislocation – This can occur due to small mid-wrist solar swelling.

3. Wasting :

Incase of wasting, we have to see this things :

  • Fore arm muscles
  • Median nerve palsy, Carpal tunnel syndrome – Thenar eminence wasting
  • Ulnar nerve palsy – Hypothenar eminence

II. ‘Feel’ or ‘Palpation’ of wrist joint :

1. Swelling :

The examiner can palpate few some things like :

  • Tenosynovitis
  • Synovial thickening in rheumatoid arthritis
  • Thyroid disease
  • Compound palmar ganglion

2. Temperature :

  • The examiner uses the back of the dominant hand to feel and compare the temperature, first at normal wrist, second at abdominal wrist and then the normal wrist.
  • Serially from the dorsal, velar, radial and ulnar side of the wrist.

3. Tenderness :

During the palpation of the tenderness, we have to find out at different places :

  1. Smith’s fracture & Barton’s fracture
  2. Bennett’s fracture
  3. Scaphoid fracture, and the distal 1/4th of the radius
  4. The distal radio-ulnar joint

5. Joint line :

  • At the Inter styloid line, the examiner can feel a gap.
  • The gap opens and closes with wrist movement
  • This is known as the dorsal joint line of the wrist

6. Distal radio-ulnar joint instability :

Also known as Piano key sign.

  1. With one hand, the examiner attempts to subluxate the DRUJ by applying volarly directed stress on the ulnar head and looking for aberrant movement.
  2. Then notes and compares the the opposite site also.
  3. Finally comments on the matter.

III. Movements of wrist joint :

1. Radio Ulnar deviation :

  • The examiner flex the patient’s elbow to 90 degrees, with the forearm pronated.
  • The examiner grasps the patients forearm with one hand, and the palm with the opposite hand.
  • Then the examiner gradually deviates the hand first medially and then laterally, to make sure that there is no palmar flexion or dorsiflexion.

2. Dorsiflexion :

  • The patient is asked to make a prayer like hand with both the thenar and hypothenar part of the hand touch their counterparts.
  • Then the patient is requested to maintain the palm contact and simultaneously elevate also.
  • This is the dorsiflexion, now the examiner notes and comments.

3. Palmarflexion :

  • Now here the patient is requested to contact both the dorsum of the wrist, hand and fingers.
  • Then, The patient is requested to lower the elbow gradually.
  • This is the Palmar flexion. now the examiner notes and comments.

IV. Measurement of wrist joint :

1. Linear measurement :

  • In linear measurement, we used to measure the length of the forearm.

2. Circumferential measurement :

  • By this measurement we measure the muscle wasting or swelling
  • The girth of the wrist and forearm is measured

VI. What are the special tests

  1. Muscle testing
  2. Maisonneuve’s test – This test is done to confirm the hyperextension at the pathological wrist joint.
  3. Grip test
  4. Grind test
  5. Flexor digitorum superficialis (FDS)
  6. FLP(Flexor pollicis longus)+ EPL(Extensor pollicis longus)
  7. Bunnell-Littler test
  8. Watson test