Wrist Examination: Central-Dorsal Region
Christos Karagiannopoulos, PT, PhD, ATC, CHT
Assistant Professor, DeSales University
Doctor of Physical Therapy Program
Anatomy
• Osseous structures
– Dorsal rim of the distal radius
– Lister’s Tubercle
– Lunate
– Scapho-lunate interval
– Capitate
– Base IInd and IIIrd MC
Anatomy
• Soft tissue structures: – ECRB/ECRL (2nd Comp)
– EPL (3rd comp)
– EDC/EIP (4th Compartment)
– Posterior Interosseous Nerve
Palpation
• Dorsal rim of distal radius – Dorsal - central from radial styloid
– Radio-carpal OA: Osteophytes
– Scaphoid impingement with wrist extension
• Listers Tubercle – Prominence over mid-dorsal distal radius
– Demarks
• S-L interval
• Scaphoid /lunate fossa
• 3rd ext compartment
• EPL tendon
Palpation
• Lunate – Distal and ulnar to Lister’s Tubercle
– Wrist flexed
– Rounded prominence
– Clinical implications • Keinbock’s Disease:
– Avascular necrosis of lunate
– Peri-lunate joint OA
– Carpal collapse
Palpation
• Scapho-lunate Interval – Distal to Lister’s tubercle
– Between EPL and EDC
• Swelling, Tenderness, Clicking
– Clinical implications: • Occult ganglion
• Dorsal wrist syndrome: Isolated joint synovitis
• S-L instability
Palpation
• Capitate – Prox → dorsal IIIrd MC base
– Small depression
– Distal to lunate
– Clinical implications: • Mid-carpal instability
• SLAC wrist: – End-stage degenerative
– Altered carpal bone alignment
– Proximal capitate migration » SL, SC, STT, LT instability
Palpation
• 2nd and 3rd MC bases
• CMC Joints
• Clinical implications – CMC joint sprain: Forced wrist flexion
– ECRL/B insertional tendinosis
– Carpal boss: Bony prominence
• CMC Joint/tendon/bone hypertrophy
– Joint sprain
– Degenerative process
– Trauma - Osteophites
Palpation
• ECRL/ECRB – 2nd ext compartment
– Radial and distal to Lister’s tubercle
• EDC – 4th Ext compartment
– Ulnar to EPL and Lister’s tubercle
Palpation
• Posterior Interosseous Nerve (PIN) • Motor nerve to deep dorsal compartment
• Innervates dorsal wrist capsule
• Wrist proprioceptive feedback
– Symptoms: • Tenderness
• Radiating pain at dorsal proximal wrist
– Clinical implication: • PIN Neuritis
• Post surgical neuromas
• Dorsal wrist ganglion
Clinical Test
• Resisted Middle Finger Extension Test: – Resisted long finger extension
– Wrist flexed
– Pain is provoked over the S/L interval
– Clinical significance:
• Dorsal wrist syndrome
– S/L synovitis
– S/L ligament strain or instability
Clinical Test
• Scaphoid Shift Test (Watson’s Test) (Watson et al., 1988)
– Step 1: Pressure over volar scaphoid tubercle
• Scaphoid sublux stress
– Step 2: Passive UD/Ext → RD/Flex
• Pressure is released
• (+) Reproduction of painful “Click or Thunk”
– Scaphoid volar shift
– Grades: 0 No shift, +1 Mild “click”, +2 Audible “clunk”
• LR+ = 2.76, LR- = 0.25 (Valdes K, 2013)
– Clinical Significance: • SL laxity or instability
• Volar scaphoid subluxation
Clinical Test
• Scapho-lunate Ballottement Test – Stabilization of lunate with one hand
– Shifting scaphoid in volar-dorsal direction with other hand
– Clinical Significance: • Reproduction of pain & “click”
• Scapho-lunate instability
Clinical Test
• Best 5 confirmatory clinical signs for S/L dissociation
– S/L interval tenderness – Scaphoid tenderness – STT joint tenderness – Watson’s test – Resisted middle finger extension
Watson et al., 1988
Clinical Tests
• Linscheid Test – Detect ligament or instability at II & III MCP joints
– Support MC shafts with one hand
– Press MC heads in palmar and dorsal direction
• Clinical significance: – (+) Pain provoked at CMC joints
Clinical Tests
• Tenosynovitis: – Pain reproduction
– EDC resist or AROM • Resist MCP Extension
– ECRB/ECRL • Resist wrist extension
– Lumbricals • Resist PIP/DIP Ext
Top Related