History and Clinical

Examination of Wrist & Hand

Mr Wong Chya Wei B Med Sci BM BS(Nottm) FRCS(ED) AM

Consultant Orthopaedic Surgeon
Sibu Specialist Medical Centre

Pakar Perunding Ortopedik (Sessional Swasta)

Hospital Sibu
Examination of the hand
is an examination of the
sense of touch.
 There are 27 bones in the hand and 2
more at the wrist (Radius and ulnar)

 52 joints
Hand and wrist as an
extension of the body
Always treat the patient
as a whole
Think about systemic
manifestation of hand
symptoms

e.g. clubbing
How I examine the wrist

 History

 Physical examination
- LOOK
- FEEL
- MOVE
History

 Site of pain
 How it occur?
 What the patient cannot do?
Physical Examination

Look & Compare

Physical Examination
 Wasting of thenar eminence

 abductor pollicis brevis,
adductor pollicis, opponens
pollicis, and flexor pollicis brevis
Physical Examination

Feel
Accurate palpation of all structures
around the wrist joint

Know your anatomy!

Physical Examination

MOVE

 Understand normal wrist movement

- palmar flexion with ulnar deviation
- dorsi flexion with radial deviation
Physical Examination
 Pronation

 Supination
Special Test

Tinel’s sign

Phalen test

Finkelstein’s test
How I examine the hand?

 History

 Physical Examination
- Look
- Feel
- Move
How I examine the hand?
Assessment of injured
hand

 Quick and gross assessment is adequate

DETAILED EXAMINATION IN THE A&E IS OF
MINIMAL VALUE
History
How did it happen [Mechanism]?
Where did it happen?
When did it happen?
Other history
 Aid the management
– Age
– Sex
– Dominant hand
– Involved hand
– Occupation and socioeconomic status
– Associated injuries
– General condition
What Happen to……

 Skin
 Muscle
 Tendons
 Nerve
 Vessel
 Bones & Joints
Skin

 Epidermis is contused, stretched and

sometimes torn
 There may be skin avulsion
Muscle
 Tearing of the
fascia
 Crushing and
rupture of the
muscle substance
 Avulsion of the
muscle from their
tendon at either the
origin or insertion
 Devascularisation
 Enervation
Nerves

 Nerves resist contusion well

Bone and Joint
 Fractures are usually
– open
– displaced
– comminuted
– Unstable

 Tearing of the capsule and

the ligaments with
comminuted intra-articular
fractures, subluxations and
dislocations
In Outpatient….

 History

 Physical Examination
- Look
- Feel
- Move
History
 Pain/numbness/swelling/weakness

 Duration/location/radiation

 Precipitating factor/relieving factor

 Recent changes

 Etc…
History
 Aid the management
– Age
– Sex
– Dominant hand
– Involved hand
– Occupation and socioeconomic status
– Associated condition
– General condition
Physical Examination

Feel

 Temperature
 Crepitus
 ‘trigger point’
Physical Examination

Move

Active

Passive
Assessment Tools
 Dynamometer

Goniometer
Assessment of
functional outcome
is more important
Investigation
Summary

 Thorough knowledge of anatomy

 Basic understanding of mechanics

 Good history

 Relevant examination