OnExam

Inspection

  • Inspect the dorsal and volar surfaces of wrist
    • Radial styloid
    • Ulnar styloid
    • Thenar (median nerve) and hypothenar (ulnar nerve) eminences for muscle wastingul>
    • Radius/Ulna for deformity (eg.Colles or Smith's Fractures)

Palpation

  • Note areas of pain, swelling, spasm, atrophy, ligamentous laxity, deformity or crepitus in the following structures:
    • Radial styloid process
    • Ulnar styloid process
    • Carpal bones
    • Radioulnar articulation
    • Scaphoid within anatomic snuffbox
    • Abductor pollicis longus
    • Extensor pollicis brevis
    • Extensor pollicis longus
    • Thenar and hypothenar eminences
    • Radial and ulnar pulses

Range of Motion

  • Flexion (normal = 90°), “Palm towards forearm”
  • Extension (normal = up to 70°), “Back of hand towards forearm”
  • Ulnar deviation (normal = up to 50°), “5th finger towards forearm”
  • Radial deviation (normal = up to 20°), “Thumb towards forearm""
  • Carpal Tunnel Syndrome Tests

    References

    1. Baxter S, ed., McScheffrey G, ed. Toronto Notes: Comprehensive Medical Reference & Review for MCCQE 1 & USMLE 2. 26th ed. Toronto: Toronto Notes for Medical Students Inc; 2010.
    2. Bickley L. Bate’s Guide to Physical Examination and History Taking. 10th ed. New York: Lippincott Williams & Wilkins; 2009.
    3. Hurley K. OSCE and Clinical Skills Handbook. Halifax: Elsevier Canada; 2005.