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Wrist Examination

Wrist Examination. S.Fallatah A.Giachino April 24/02. The key to correct examination of the wrist is precise location of the symptoms relating to the underlying anatomical structures.

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Wrist Examination

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  1. Wrist Examination S.Fallatah A.Giachino April 24/02

  2. The key to correct examination of the wrist is precise location of the symptoms relating to the underlying anatomical structures. • A beauty of wrist examination is that almost all bony, articular, tendinous or vascular structures may be palpated through the overlying skin

  3. Positioning • Palpation • Range of motion • Special tests • Bilateral comparison

  4. Inspection • Observe the hand in function • Swelling • Rash • Deformity • Scars • Color and condition of nails • The contour of both palmer and dorsal surfaces

  5. Palpation • Skin palpation • The skin of both the palm and the palmer surface of the fingers is much thicker than that of the dorsal surface • The skin of the fingers is fixed to bone by septa and small ligaments • Check for any unusually worm or dry areas • Particular attention to any lesions

  6. Bony palpation • Start by palpating the radial and ulnar styloid processes(the basic reference points of the carpal region) • Bones of the wrist

  7. Radial styloid process…truly lateral • Anatomic snuffbox..distal and slightly dorsal to the radial styloid process,becomes outlined&palpable when the patient extends his thumb • Scaphoid(Navicular)..the floor of the snuffbox,palpable on ulnar deviation of the wrist • Trapezium/1st metacarpal articulation

  8. Lister’s tubercle..1/3 of the way across the dorsum of the wrist from the radial styloid process • Capitate..the largest of all the carpal bones • Lunate • The lunate,capitate,and the base of the 3rd metacarpal are in line with each other

  9. Ulnar styloid process • Triquetrium..with radial deviation of the wrist • Pisiform • Hook of the Hamate • Metacarpals • Metacarpophalangeal joints • Phalanges

  10. Soft tissue palpation • Clinical zones of the wrist and the hands • Six extensor compartments(tunnels) and two flexors compartments.

  11. wrist • Zone I : Radial styloid process • anatomicsnuffbox,1st extensor compartement • Zone II:Lister’s tubercle • 2nd,3rd, and 4th extensors compartements • Zone III: Ulnar styloid process • 5th and 6th compartements • Zone IV: Pisiform(palmar aspect) • FCU,Tunnel of Guyon,and ulnar artery • Zone V: • palmaris longus,carpal tunnel,and FCR

  12. Hand • Zone I: Thenar eminence • APB,OP,FPB • Zone II: Hypothenar eminence • ADQ,OD,FDQ • Zone III: Palm • Palmar aponeurosis& fingers flexor tendons • Zone IV: Dorsum • Extensor tendons • Zone V: Phalages • Zone VI : Tufts of the fingers

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