Although only 39% of patients presenting to the emergency department with wrist trauma have sustained a fracture, the majority of patients are routinely referred back for radiography. For this reason, the Caradeniz wrist rules were developed in order to decrease the number of x-rays in suspected distal radius, distal ulna and carpal bone fractures within 24 hours after acute wrist traumas.
According to Karaca et al. (2016), the Caradeniz wrist rules have a sensitivity of 100% and a low specificity of 6.6 % in the detection of wrist fractures. These results have not been externally validated yet, which is why we give the rule a moderate clinical value to rule out wrist fractures.
The Decision Rule contains the following items. Due to their provocative nature, we propose the following order:
Ask your patient to perform active dorsiflexion of the wrist
Ask your patient to perform active radial deviation
Palpate the distal ulna for sensitivity
The radioulnar drawer test: Stabilize your patient’s distal radius with the dorsum of his hand facing upwards. Then apply alternating dorsal-volar stress to the distal ulna. This test is positive if you patient reports pain or if there is increased movement compared with the other side.
Axial compression tests: Hold on to the metacarpal bone and give axial pressure on the rapezium and scaphoid. Perform the same axial pressure with the metacarpal bones 2 – 5.
All of the 5 items are considered positive if pain is provoked. In the radioulnar drawer test, an increased amplitude of movement compared to the other side is considered as a positive test as well.
In case all 5 items are negative, a fracture of the radius, ulna, and carpal bones could be ruled out with 100% confidence in the study of Karaca et al. (2016).
21 OF THE MOST USEFUL ORTHOPAEDIC TESTS IN CLINICAL PRACTICE
If you want to screen for fractures in other body parts, check out the list below:
What customers have to say about the Assessment E-Book
The Assessment E-Book This book helped me in my studying for my exam and in assessing my first patients. Awesome! Also for beginners!
The Assessment E-Book It’s an amazing Compilation! Congrats to all the work you have put in there. You’ll propably find all the test’s you’ve been looking for with propper explaination and source to doublecheck for you self. definetly a must have for every student, but it will also help an experienced practioner. Im looking forward to the lifelong updates on the topics.
Great work, guys
The Assessment E-Book A must-have for all physiotherapists, osteopaths and manual therapists. The authors conducted an extensive research on assessment tests in manual therapy. I find it very easy to read. The more I read the more I learn. Thank you!
The Assessment E-Book This book is great! It is very structured and detailed. It works extremely well on my Macbook and iPad.
The Assessment E-Book The best way to spend 80euros. Totally worth it. The amount of work you put behind this must have been absolutely huge. Every physical or physiotherapist should own it.
Congrats guys you’ve done an incredible job.
I’ve learnd a lot of new things and my approach to therapy in general have totally changed.
In one word: amazing. Keep going guys ! Best wishes from france.
The technical storage or access is strictly necessary for the legitimate purpose of enabling the use of a specific service explicitly requested by the subscriber or user, or for the sole purpose of carrying out the transmission of a communication over an electronic communications network.
The technical storage or access is necessary for the legitimate purpose of storing preferences that are not requested by the subscriber or user.
The technical storage or access that is used exclusively for statistical purposes.The technical storage or access that is used exclusively for anonymous statistical purposes. Without a subpoena, voluntary compliance on the part of your Internet Service Provider, or additional records from a third party, information stored or retrieved for this purpose alone cannot usually be used to identify you.
The technical storage or access is required to create user profiles to send advertising, or to track the user on a website or across several websites for similar marketing purposes.