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Wrist Evaluation

Part 2. Wrist Evaluation. Overview. Observation Examination AROM/PROM Special tests Neurological exam Circulatory exam. Observation. Overall position of person Are they using the involved limb? Is the wrist or hand in an abnormal position? Is the limb hanging limp? Swelling

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Wrist Evaluation

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  1. Part 2 Wrist Evaluation

  2. Overview • Observation • Examination • AROM/PROM • Special tests • Neurological exam • Circulatory exam

  3. Observation • Overall position of person • Are they using the involved limb? • Is the wrist or hand in an abnormal position? • Is the limb hanging limp? • Swelling • Skin color • Signs of trauma • Skin temperature

  4. Observation • Deformities • Atrophy • Abnormalities • Compare • Carrying angle • Muscle spasm

  5. Palpation • Navicular /scaphoid • Lunate • Triquetrium • Pisiform • Trapezium • Trapezoid • Capitate • Hamate

  6. Palpation • Lister’s tubercle • Metacarpals • Phalanges • Thenar eminence (base of thumb, palmar aspect) • Hypothenar eminence (little finger side, palmar aspect)

  7. Palpation • Radius • Ulna • Radial styloid process • Ulnar styloid process • Metacarpo-phalangeal (MP) joints • Proximal Interphalangeal (PIP) joints • Distal Interphalangeal (DIP) joints

  8. Palpation • Anatomical snuff box • Tunnel of Guyon • Carpal tunnel

  9. Palpation: Soft Tissue • Median nerve • Ulnar nerve • Radial nerve • Transverse carpal ligament • Ulnar collateral ligament • Radial collateral ligament • Ulnar artery • Biceps brachii • Brachioradialis • Pronatorteres • Pronatorquadratus

  10. Palpation: Soft Tissue • Supinator • Extensor carpi radialis longus • Extensor carpi radialis brevis • Extensor carpi ulnaris • Extensor digitorum • Extensor pollicis longus • Extensor pollicis brevis

  11. Palpation: Soft Tissue • Flexor carpiradialis • Flexor carpiulnaris • Flexor digitorumprofundus • Flexor digitorumsuperficialis • Flexor pollicuslongus • Flexor pollicisbrevis • Abductor pollicusbrevis • Adductor pollicus • Abductor digitiminimi • Palmarinterossei • Palmaris longus

  12. Examination • AROM/PROM • Wrist: • Flexion • Extension • Circumduction • Radial deviation • Ulnar deviation • Supination • Pronation

  13. Examination • AROM/PROM • Fingers: • Flexion (each joint) • Extension (each joint) • Abduction (of each finger) • Adduction (of each finger) • Opposition (thumb and 5th finger) • Pinch (thumb and index finger) • Thumb: • Abduction • Adduction • Circumduction

  14. Neurologic Exam: Sensory • Sensory dermatomes • C2-C3: Occipital area and angle of jaw • C4: Supraclavicular area • Axillary Nerve Patch: Lateral aspect of shoulder • C5: Lateral upper arm • C6: Lateral forearm, thumb, and index finger • C7: Middle finger and palmar aspect of hand • C8: Small finger, ring finger, and medial portion of palmar surface • T1: Medial side of forearm and elbow • T2: Medial aspect of upper arm • T3: Medial aspect of upper arm

  15. Neurologic Exam: Motor • C1-C2: Neck flexion • C1-C2: Neck extension • C3: Neck lateral flexion • C4: Shoulder elevation • C5: Shoulder abduction and external rotation • C6: Elbow flexion and wrist extension • C7: Elbow extension and wrist flexion • C8: Thumb abduction and ulnar deviation • T1: Finger approximation

  16. Neurologic Exam: Reflexes • Biceps (C5-C6) • Supinator (C5-C6) • Triceps (C7-C8)

  17. Circulatory • Carotid • Brachial • Radial

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