Patient’s Name

DOB
MRN
Date of Visit
Wrist & Hand H & P
HPI
History elements to ask:
- Onset/duration of symptoms
- Mechanism of injury/
- Acute traumatic, overuse, or spontaneous onset
- Location of pain
- Radiation of pain
- Numbness or tingling
- Provoking/alleviating factors

PMH
Prior wrist/hand injuries or surgery Other orthopedic history (surgeries, arthritis, trauma, etc…)
---------------------------------------------------------------------------------------------------------------------------------------------------
Physical Exam KEY: Y = Yes (positive) N = No (negative) NE= Not Examined
Inspection Special Tests
Swelling Y N NE Carpal Tunnel
Erythema Y N NE Phalen’s Test Y N NE
Bruising Y N NE Tinel’s Test Y N NE
Thenar Atrophy Y N NE Cubital Tunnel
Mallet Deformity Y N NE Tinel’s Test (Elbow) Y N NE
Boutonniere Deformity Y N NE DeQuervain’s Tenosynovitis
Heberden’s Nodes Y N NE Finkelstein’s Test Y N NE
Bouchard’s Nodes Y N NE Scapholunate instability
Other Deformity:________________________________ Watson’s Test Y N NE
Triangular Fibrocartilage Injury
ROM Loaded Circumduction Y N NE
Wrist Flexion Y N NE
Wrist Extension Y N NE Palpation (pain elicited)
Wrist Ulnar Deviation Y N NE Distal Radius Y N NE
Wrist Radial Deviation Y N NE Distal Ulna Y N NE
MCP/PIP/DIP Jt Flexion Y N NE Anatomic Snuffbox Y N NE
MCP/PIP/DIP Jt Extension Y N NE Scaphoid tubercle (volar) Y N NE
Finger Rotational Abnl Y N NE TFCC (dorsal ulnar wrist) Y N NE
Ulnar Collateral Lig (thumb) Y N NE
Strength Metacarpal Y N NE
Wrist Flexion Y N NE PIP/DIP Joint Y N NE
Wrist Extension Y N NE
Grip Strength Y N NE Neurovascular
Thumb Opposition Y N NE Sensation: 2 point discrimination (<10 mm)
Flexor Superficialis (PIP) Y N NE Medial Nerve Distribution Y N NE
Flexor Profundus (DIP) Y N NE Ulnar Nerve Distribution Y N NE
Extension PIP/DIP Y N NE Radial Nerve Distribution Y N NE
Finger Ab/Aduction Y N NE Distal pulses Y N NE
---------------------------------------------------------------------------------------------------------------------------------------------------
Assessment (circle suspected diagnosis)
Wrist Sprain TFCC Tear Boxer’s Fracture Flexor Tendon Rupture
Distal Radius Fracture DeQuervain’s Tenosynovitis Thumb UCL Injury Dupuytren’s Contracture
Distal Ulnar Fracture Intersection syndrome PIP/DIP Joint Sprain Rheumatoid Arthritis
Carpal Tunnel Syndrome Keinbock’s Disease Bouttonniere Deformity Psoriatic arthritis
Cubital Tunnel Syndrome Scaphoid Fracture Mallet Finger Gout
Ganglion Cyst 1st CMC Arthritis Trigger Finger Other:___________________

Plan
1) Treatment: (Circle all employed)
General: Rest Ice Aspiration/Injection:____________________________________
Finger Splint: Buddy Tape Extension Cast:________________________________________________
Wrist Splint: Neutral Thumb Spica
2) Medications:
NSAIDs Y N Specify:________________________ Other:_____________________________________
3) Imaging:
X-rays Y N MRI Y N If yes, specify test ordered:_____________________
4) Referral: Sports Med Y N Orthopedics Y N Physical Therapy Y N
5) Follow up: _______________
©Ashwin Rao and Jonathan Drezner, 2007
 Figure 1: Surface anatomy of t he hand, as seem from the Figure 2- Bony anatomy of the wrist
dorsal and palmar surfaces

Figure 5- Heberden’s (DIP) and

Figure 3- Sensory nerve distribuation of hand, as seen from palmar view (left) Figure 4- This image
and dorsal view (right). #1= ulnar nerve. #2 = median nerve. # 3 = radial nerve Bouchard’s (PIP) nodes, seen in
demonstrates severe thenar
advanced osteoarthritis of the hand
atrophy

Figure 6: Mallet finger, caused by a
disruption in the extensor digitorum
tendon at its insertion at the base of
the distal phalynx
Figure 7: Dupuytren’s
contracture: A nodular thickening
of the palmar fascia, associated
with DM, epilepsy, pulmonary
disease, and alcoholism.
Figure 8: Tinel’s test of the wrist,
which aids in the diagnosis of carpal
tunnel syndrome
Figure 9: Phalen’s Test. This postion, with
both wrists flexed and opposed, should be
held for at least 30 seconds. Paresthesias
along the median nerve distribution suugests
carpal tunnel syndrome.

Figure 10: Finkelstein’s test. With the thumb
flexed in the hand, the wrist is flexed and ulnar-
deviated. Pain at the dorsoradial aspect of the wrist
suggests DeQuervain’s tenosynovitis (involving
the abductor pollicus longus and extensor pollicus
brevis tendons).
Figure 11: The Watson or Scaphoid Shift Test. The
physician's thumb is placed on the scaphoid tubercle while
the patient's wrist is in ulnar deviation. Pressure is applied
dorsally. The patient radially deviates the wrist. Pain
indicates scapholunate ligamentous instability.
Figure 12: Froment sign. Ask the patient to
pinch a piece of paper between the thmb and
index finger tips. Flexion at the thumb IP joint
on paper traction suggests weakness of the
adductor pollicus muscle, consistent with ulnar
nerve paralysis. Compare with opposite thumb.