Wrist and Hand Examination

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Subjective

Thorough history taking is an important first step in treating the patient. Each physical therapist will develop their own style and technique, but a good interview will include the basic elements discussed below.

History

Clinical Presentation
        Mechanism of the injury-
                How the injury occurred and what was the cause.
        Location of the pain
        Timeline-
                When is the pain at its worse and when is it relieved?
        Presence and location of numbness and tingling.
        Aggravating and relieving factors.
        Were any diagnostic test/imaging performed and what were the results?

Red Flags

This section deals with screening the patient for possible serious pathologies that could cause wrist or hand pain. These conditions could warrant a referral, or consultation.

Infections

• Heat
• Swelling
• Pain
• Redness
• Inflammation

Fracture/dislocation:

Top five physical findings which are most useful in screening for wrist fracture.1

• Localized tenderness (Sensitivity [Sn] 94%)
• Pain on active motion (Sn 97%)
• Pain on passive motion (Sn 94%)
• Pain on grip (Sn 71%)
• Pain on supination (Sn 68%)
• Bottom line: Any one of the above findings associated with a history of trauma should be sent for radiographs

Colles fracture
Scaphoid fracture
Additional potentially serious conditions

• Scapholunate instability
• Arthritedes
• Rheumatoid Arthritis
• Lyme disease
• Tuberculosis

Peripheral Vascular Disease
Peripheral Neuropathy:

• Hx: Older age, >65. The risk is same for men/women.
• Risk factors include hypertension, hypercholesterolemia, obesity, diabetes, and smoking. Commonly affects lower extremity over upper extremity.

Upper extremity nerve injuries involving

• Median
• Radial
• Ulnar
  
  

Differential Diagnosis

Carpal Tunnel Syndrome
Anterior Interosseous Syndrome
Posterior Interousseous Syndrome
Fractures

• Distal Radial Fractures

Osteoarthritis

• First Carpometacarpal Osteoarthritis
•         Thumb CMC grind test
• Hand and Wrist Osteoarthritis

DeQuervain Syndrome

• Finklestein’s Test:

Radial Tunnel Syndrome
Compression of the Ulnar nerve at Guyon’s canal
Non-specific wrist pain (mechanical wrist pain)

• Can include wrist strain, sprain, joint dysfunction, repetitive injuries or h/o trauma without specific identified diagnosis.

Trigger Finger
Complex Regional Pain Syndrome
Triangular Fibrocartilaginous Complex
Dupuytren’s Contracture

Outcome Measures

• DASH:
• Quick DASH
• Symptom Severity Scale
• Patient Specific Functional Scale

Objective

Observation

• Posture
• Movement Patterns

Palpation

• supine
• prone
• seated

Movement Testing

• AROM, PROM, and Overpressure
• Passive Intervertebral Motion
• Muscle Strength