Post on 23-Feb-2016
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WRIST EVALUATIONPart 2
Overview
Observation Examination
AROM/PROMSpecial testsNeurological examCirculatory exam
Observation
1. Overall position of person 2. Are they using the involved limb? 3. Is the wrist or hand in an abnormal
position? 4. Is the limb hanging limp? 5. Swelling 6. Skin color 7. Signs of trauma 8. Skin temperature
Observation
9. Deformities 10.Atrophy 11.Abnormalities 12.Compare 13.Carrying angle 14.Muscle spasm
Palpation
1. Navicular /scaphoid2. Lunate 3. Triquetrium 4. Pisiform5. Trapezium 6. Trapezoid 7. Capitate 8. Hamate
Palpation
9. Lister’s tubercle 10.Metacarpals 11.Phalanges 12.Thenar eminence
(base of thumb, palmar aspect)
13.Hypothenar eminence (little finger side, palmar aspect)
Palpation
14.Radius 15.Ulna 16.Radial styloid process 17.Ulnar styloid process 18.Metacarpo-phalangeal (MP) joints 19.Proximal Interphalangeal (PIP) joints 20.Distal Interphalangeal (DIP) joints
Palpation
21.Anatomical snuff box
22.Tunnel of Guyon 23.Carpal tunnel
Palpation: Soft Tissue
1. Median nerve 2. Ulnar nerve 3. Radial nerve 4. Transverse carpal ligament 5. Ulnar collateral ligament 6. Radial collateral ligament 7. Ulnar artery 8. Biceps brachii 9. Brachioradialis 10.Pronator teres 11.Pronator quadratus
Palpation: Soft Tissue
12.Supinator 13.Extensor carpi radialis longus 14.Extensor carpi radialis brevis 15.Extensor carpi ulnaris 16.Extensor digitorum 17.Extensor pollicis longus 18.Extensor pollicis brevis
Palpation: Soft Tissue
19.Flexor carpi radialis 20.Flexor carpi ulnaris 21.Flexor digitorum profundus 22.Flexor digitorum superficialis 23.Flexor pollicus longus 24.Flexor pollicis brevis 25.Abductor pollicus brevis 26.Adductor pollicus 27.Abductor digiti minimi 28.Palmar interossei 29.Palmaris longus
Examination
AROM/PROM Wrist:
1. Flexion 2. Extension 3. Circumduction 4. Radial deviation 5. Ulnar deviation 6. Supination 7. Pronation
Examination
AROM/PROM Fingers:
1. Flexion (each joint) 2. Extension (each joint) 3. Abduction (of each finger) 4. Adduction (of each finger) 5. Opposition (thumb and 5th finger) 6. Pinch (thumb and index finger)
Thumb: 1. Abduction 2. Adduction 3. Circumduction
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
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
Neurologic Exam: Reflexes
Biceps (C5-C6) Supinator (C5-C6) Triceps (C7-C8)
Circulatory
Carotid Brachial Radial