{"id":11383,"date":"2022-08-11T10:18:42","date_gmt":"2022-08-11T08:18:42","guid":{"rendered":"https:\/\/www.physiotutors.com\/?post_type=physiotherapy&#038;p=11383"},"modified":"2025-01-30T11:05:56","modified_gmt":"2025-01-30T10:05:56","slug":"wrist-hand","status":"publish","type":"physiotherapy","link":"https:\/\/www.physiotutors.com\/physiotherapy\/wrist-hand\/","title":{"rendered":"Wrist\/Hand Assessment"},"featured_media":11129,"template":"","class_list":["post-11383","physiotherapy","type-physiotherapy","status-publish","has-post-thumbnail","hentry"],"acf":{"sections":[{"acf_fc_layout":"page-header-detail-page","background":{"background_image":11129,"background_image_alt_text":"Wrist\/Hand Assessment"},"heading":"Wrist\/Hand Assessment","subheading":"Radiocarpal, distal radioulnar joint & more","content_editor":"","button_type":"url","button_label":"","button_style":"button-two","button_internal_link":"","button_anchor":"","button_url":"https:\/\/study.physiotutors.com\/course\/orthopedic-physical-assessment\/","button_file":"","label":""},{"acf_fc_layout":"submenu","links":[{"button_type":"anchor","button_label":"Learn","button_internal_link":null,"button_anchor":"section-number-3","button_url":"","button_file":null},{"button_type":"anchor","button_label":"Extremity Online Course","button_internal_link":null,"button_anchor":"section-number-4","button_url":"","button_file":null},{"button_type":"anchor","button_label":"Reviews","button_internal_link":null,"button_anchor":"section-number-5","button_url":"","button_file":null}],"dropdown_label":"Go to","button_right":{"button_type":"internal_link","button_label":"Become a member","button_style":"button-three","button_internal_link":16662,"button_anchor":"","button_url":"","button_file":""},"button_description":""},{"acf_fc_layout":"content-content","section_options":{"vertical_alignment":"top","column_right_box":false,"column_left_width":"col-12 col-lg-4 offset"},"column_left":{"content_editor":"<h4>Learn<\/h4>"},"column_right":{"content_editor":"<h3><strong>Introduction \u00a0<img class=\"alignright\" draggable=\"false\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/d\/da\/Carpus_%28left_hand%29_-_animation01a.gif\" alt=\"\" \/><\/strong><\/h3>\r\nThe wrist is one of the most complex anatomical structures and features eight bones that are collectively known as the carpus or carpal bones. The carpus is comprised of the <strong><span style=\"color: #ff00ff;\">scaphoid<\/span><\/strong>, <strong><span style=\"color: #00ffff;\">lunate<\/span><\/strong>, <strong><span style=\"color: #339966;\">triquetrum<\/span><\/strong>, <strong><span style=\"color: #ff0000;\">pisiform<\/span><\/strong>, <strong><span style=\"color: #614500;\">trapezium<\/span><\/strong>, <strong><span style=\"color: #004500;\">trapezoid<\/span><\/strong>, <span style=\"color: #d4bf02;\"><strong>capitate<\/strong><\/span>, and <strong><span style=\"color: #0000ff;\">hamate<\/span><\/strong>.\r\nMoving distally, we will have the metacarpals and phalangeals, as well as the distal radius and ulna.\r\n\r\n&nbsp;\r\n<h3><strong>Epidemiology<\/strong><\/h3>\r\nWrist and hand pain is reported to have a point prevalence of about 13% with women being almost twice as often affected as men across all age groups (<a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/12620608\" target=\"_blank\" rel=\"noopener\">Picavet et al. 2003<\/a>).\r\n\r\n&nbsp;\r\n<h3><strong>Course<\/strong><\/h3>\r\nThe Dutch GP Association reports on the course of wrist and hand pain (<a href=\"https:\/\/www.nhg.org\/standaarden\/volledig\/nhg-standaard-hand-en-polsklachten\" target=\"_blank\" rel=\"noopener\">NHG 2010<\/a>). The course of wrist and hand pain appears to be unfavorable as only 25% of patients recover after three months and 40% after one year. <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/22794500\" target=\"_blank\" rel=\"noopener\">Prosser et al. (2012)<\/a> report that patients who received arthroscopy for nonspecific wrist pain had a 50% chance to have moderate levels of pain and low levels of disability one-year post-surgery.\r\n\r\n&nbsp;\r\n<h3><strong>Prognostic factors (<\/strong><strong><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/28096253\" target=\"_blank\" rel=\"noopener\">Artus et al. 2017,<\/a>\u00a0<a href=\"https:\/\/www.nhg.org\/standaarden\/volledig\/nhg-standaard-hand-en-polsklachten\" target=\"_blank\" rel=\"noopener\">NHG\u00a02010,<\/a>\u00a0<a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/22794500\" target=\"_blank\" rel=\"noopener\">Prosser et al. 2012<\/a><\/strong><strong>)<\/strong><\/h3>\r\nThe following prognostic factors are specifically described for the wrist and hand:\r\n<ul>\r\n \t<li>old age<\/li>\r\n \t<li>female gender<\/li>\r\n \t<li>long duration (&gt;3 months)<\/li>\r\n \t<li>somatisation (+ fracture = increased risk for CRPS)<\/li>\r\n \t<li>less control over pain and function<\/li>\r\n \t<li>baseline Patient-Reported Wrist and Hand Examination (PRWHE)<\/li>\r\n<\/ul>\r\nFurthermore, you should not forget the prognostic factors for general MSK complaints by Artus et al.:\r\n<ul>\r\n \t<li>widespread pain<\/li>\r\n \t<li>high functional disability<\/li>\r\n \t<li>somatization<\/li>\r\n \t<li>high pain intensity<\/li>\r\n \t<li>presence of previous pain episodes<\/li>\r\n<\/ul>\r\n&nbsp;\r\n<h3><strong>Red flags<\/strong><\/h3>\r\nThere are several specific pathologies that count as red flags. These are:\r\n\r\n<strong>Fractures<\/strong>\r\n\r\nCommon fractures are those of the scaphoid, distal ulna, and distal radius.\r\nDistal radius fractures are:\r\n<ul>\r\n \t<li>Smith fractures: distal head of the radius fractures with volar angulation of the fragment(s)<\/li>\r\n \t<li>Colles fractures: Most common after FOOSH (fall on an outstretched hand) trauma. Impact of the scaphoid on the distal radius leads to fracture and dorsal angulation of the radial fragment(s)<\/li>\r\n<\/ul>\r\n<a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/27450389\" target=\"_blank\" rel=\"noopener\">Karaca et al (2016)<\/a>\u00a0developed the Karadeniz Wrist Rule to screen for fractures of the wrist. Check the video below to learn how to do them.\r\n\r\n<iframe src=\"https:\/\/www.youtube-nocookie.com\/embed\/pRG4PUSOkmo?rel=0&amp;showinfo=0\" width=\"560\" height=\"315\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe>\r\n\r\n&nbsp;\r\n\r\n<strong>Ligament Lesions<\/strong>\r\n\r\n<strong><em>\"Gamekeeper's thumb\/ski pole thumb\" (Opposition trauma)<\/em><\/strong>\r\n\r\n<img class=\"wp-image-11697 aligncenter\" src=\"https:\/\/physiotutors.com\/wp-content\/uploads\/study\/2018\/10\/Steiner-Laesie.png\" alt=\"\" width=\"265\" height=\"338\" \/>\r\nUsually due to a fall: when skiing, the thumb may be injured in a fall, caught in the ski pole loop. \"Gamekeeper's thumb\" refers to an old task that Scottish gamekeepers had to do, which led to repetitive strain on the ulnar collateral ligament (UCL) of the thumb. In severe cases, the UCL displaces proximal and superficial to the adductor aponeurosis. This is called a\u00a0<i>Stener Lesion <\/i>(<a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC5030867\/\" target=\"_blank\" rel=\"noopener\">Christensen et al. 2016<\/a>)\r\n\r\nSigns &amp; Symptoms include:\r\n<ul>\r\n \t<li>Pain<\/li>\r\n \t<li>Ecchymosis of the thumb MCP<\/li>\r\n \t<li>Weakness of pinch grasp<\/li>\r\n<\/ul>\r\n<h3><\/h3>\r\n<strong><em>Scapholunate (SL) ligament lesion<\/em><\/strong>\r\n\r\nSigns &amp; symptoms include:\r\n<ul>\r\n \t<li>Clicking and pain on the dorsoradial aspect of the wrist<\/li>\r\n \t<li>Clear wrist trauma in history<\/li>\r\n \t<li>Swelling<\/li>\r\n \t<li>Diminished grip strength &amp; reduced ROM<\/li>\r\n<\/ul>\r\n&nbsp;\r\n\r\n<strong><em>Vascularization issues \/ Decalcification<\/em><\/strong>\r\n<ul>\r\n \t<li>SNAC: Scaphoid Non-Union Advanced Collapse (due to non-healed scaphoid fracture)<\/li>\r\n \t<li>SLAC: Scaphoid-Lunated Advanced Collapse (due to ruptured SL-ligament)<\/li>\r\n<\/ul>\r\nSigns and symptoms include:\r\n<ul>\r\n \t<li>Wrist pain<\/li>\r\n \t<li>Dorsoradial swelling<\/li>\r\n \t<li>Limited ROM<\/li>\r\n \t<li>Tenderness of the radiocarpal and mid-carpal joint<\/li>\r\n<\/ul>\r\n&nbsp;\r\n<h3><strong>Basic Assessment<\/strong><\/h3>\r\nLet's start with active range of motion:\r\n\r\n<iframe src=\"https:\/\/www.youtube.com\/embed\/W9IrahLl7XA?rel=0&amp;showinfo=0\" width=\"560\" height=\"315\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe>\r\n\r\nStandard values for the range of motion in different directions are as follows:<strong>\u00a0<\/strong>\r\n\r\n<a href=\"https:\/\/physiotutors.com\/wp-content\/uploads\/study\/2017\/01\/Bildschirmfoto-2017-06-14-um-10.52.53-3.png\"><img class=\"aligncenter wp-image-6179 size-full\" src=\"https:\/\/physiotutors.com\/wp-content\/uploads\/study\/2017\/01\/Bildschirmfoto-2017-06-14-um-10.52.53-3.png\" alt=\"\" width=\"492\" height=\"874\" \/><\/a>\r\n\r\n&nbsp;\r\n\r\nAROM assessment is then typically followed by Passive Range of Motion Assessment (PROM) that you can watch with a click on the following video:\r\n\r\n<iframe title=\"YouTube video player\" src=\"https:\/\/www.youtube.com\/embed\/aqv3WfGCgDM\" width=\"560\" height=\"315\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe>\r\n\r\nDuring PROM assessment, it's important to compare the range of motion as well as the end-feel of the affected with the unaffected side.\r\n\r\n&nbsp;\r\n<h3><strong>Specific Pathologies in the Wrist &amp; Hand<\/strong><\/h3>\r\nThere are several pathologies that are commonly seen in the wrist &amp; hand. For more information, click on the respective pathology (content will be added in the near future):\r\n<ul>\r\n \t<li>Carpal Tunnel Syndrome<\/li>\r\n \t<li>De Quervain's Disease<\/li>\r\n \t<li>Triangular Fibrocartilage Complex (TFCC) Lesions<\/li>\r\n \t<li>Intercarpal Instability<\/li>\r\n \t<li>Impaired Blood Flow &amp; Vascularization<\/li>\r\n<\/ul>\r\n&nbsp;\r\n<h3><strong>References<\/strong><\/h3>\r\n<a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/28096253\" target=\"_blank\" rel=\"noopener\">Artus, Majid et al. \u201cGeneric Prognostic Factors for Musculoskeletal Pain in Primary Care: A Systematic Review.\u201d\u00a0<em>BMJ Open<\/em>\u00a07.1 (2017): e012901.\u00a0<em>PMC<\/em>. Web. 6 Sept. 2018.<\/a>\r\n\r\n<a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/14569481\" target=\"_blank\" rel=\"noopener\">Cevik, Arif Alper, et al. \"Evaluation of physical findings in acute wrist trauma in the emergency department.\"\u00a0<i>Ulusal travma ve acil cerrahi dergisi= Turkish journal of trauma &amp; emergency surgery: TJTES<\/i>\u00a09.4 (2003): 257-261.<\/a>\r\n\r\n<a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC5030867\/\" target=\"_blank\" rel=\"noopener\">Christensen, Thomas, et al. \"Long-term outcomes of primary repair of chronic thumb ulnar collateral ligament injuries.\"\u00a0<i>Hand<\/i>\u00a011.3 (2016): 303-309.<\/a>\r\n\r\n<a href=\"https:\/\/www.nhg.org\/standaarden\/volledig\/nhg-standaard-hand-en-polsklachten\" target=\"_blank\" rel=\"noopener\">Herziening, Eerste. \"NHG-Standaard Hand-en polsklachten.\"\u00a0<i>Huisarts en wetenschap<\/i>\u00a01.2010 (2010): 22-39.<\/a>\r\n\r\n<a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/27450389\" target=\"_blank\" rel=\"noopener\">Karaca, Yunus, et al. \"A study to develop clinical decision rules for the use of radiography in wrist trauma: Karadeniz wrist rules.\"\u00a0<i>The American journal of emergency medicine<\/i>\u00a034.11 (2016): 2074-2078.<\/a>\r\n\r\n<a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/12620608\" target=\"_blank\" rel=\"noopener\">Picavet, H. S. J., and J. S. A. G. Schouten. \"Musculoskeletal pain in the Netherlands: prevalences, consequences and risk groups, the DMC3-study.\"\u00a0<em>Pain<\/em>\u00a0102.1-2 (2003): 167-178.<\/a>\r\n\r\n<a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/22794500\" target=\"_blank\" rel=\"noopener\">Prosser, Rosemary, et al. \"Prognosis and prognostic factors for patients with persistent wrist pain who proceed to wrist arthroscopy.\"\u00a0<i>Journal of Hand Therapy<\/i>\u00a025.3 (2012): 264-270.<\/a>\r\n\r\n<a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3702758\/\" target=\"_blank\" rel=\"noopener\">Shah, C. M., &amp; Stern, P. J. (2013). Scapholunate advanced collapse (SLAC) and scaphoid nonunion advanced collapse (SNAC) wrist arthritis.\u00a0<i>Current reviews in musculoskeletal medicine<\/i>,\u00a0<i>6<\/i>(1), 9-17.<\/a>"}},{"acf_fc_layout":"cta-image-v2","layout":"vertical","background":"transparent","heading":"","content_editor":"<p class=\"heading-two\">Accredited online <strong>physiotherapy courses<\/strong><\/p>\r\n\r\n<ul>\r\n \t<li>Built by the experts at Physiotutors<\/li>\r\n \t<li>Best price per CEUs\/CPD Points<\/li>\r\n \t<li>Accredited in the Netherlands, Belgium, Germany, USA, UK, &amp; Australia<\/li>\r\n \t<li>Learn anywhere, any time, and at your own pace!<\/li>\r\n<\/ul>","button_type":"internal_link","button_label":"See all 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