Wrist and Hand Examination

Source: Robert E. Sallis, MD. Kaiser Permanente, Fontana, California, USA

The wrist is a complex joint made up of 8 carpal bones and their numerous articulations and ligaments. Overlying the wrist are the tendons and muscles of the hand and fingers. The hand is made up of 5 metacarpal bones, and the tendons that run to the hand overlie these bones. Finally, the fingers consist of 14 phalanges with their articulations held together by collateral ligaments and volar plates. Common mechanisms of both acute and chronic wrist injury include impact, weight bearing (which can occur in gymnastics), twisting, and throwing. Osteoarthritis of the hand commonly affects distal interphalangeal (DIP) and proximal interphalangeal (PIP) joints, while rheumatoid arthritis (RA) is seen in the metacarpophalangeal (MCP) and PIP joints.

It is important to compare the injured wrist or hand to the uninvolved side. Key aspects of the wrist and hand exam include inspection, palpation for tenderness or deformity, testing the range of motion (ROM) and strength, neurovascular assessment, ligaments and tendon testing, and the special tests.

1. Inspection

Insect both hands and wrists comparing between the sides, and look for the following:

Swelling or masses in the joints or soft tissue, commonly seen with arthritis or ganglion cysts.
Redness or warmth, which may suggest inflammation or infection.
Atrophy of muscles, which can be seen with severe nerve injury or entrapment.

2. Palpation

Wrist palpation
Ask the patient to bend the elbow; then, pal

Examination of the wrist and hand is best done following a stepwise approach, with the patient in a sitting position. The exam should begin with inspection, looking for asymmetry between the involved and uninvolved wrist and hand. This should be followed by palpation of key structures to identify tenderness, swelling, or deformity. The next step is assessing ROM, first actively and then against resistance to assess strength. Pain with resisted motion often suggests tendonitis, while weakness may suggest a tear. A neurova

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