To effectively examine a wrist, a structured approach is essential. This involves assessing both active and passive movements, while paying attention to the patient's comfort and range of motion. Here's a breakdown:
Steps for Wrist Examination
The examination of a wrist can be broken down into the following steps:
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Observation: Begin by visually inspecting the wrist for any signs of swelling, redness, or deformity. Note any abnormalities like scarring or muscle wasting.
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Finger Extension:
- Ask the patient to straighten their fingers fully, extending them against gravity.
- This action assesses the extensor muscles of the wrist and fingers.
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Fist Formation:
- Instruct the patient to make a fist.
- This evaluates the flexor muscles of the wrist and fingers.
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Active Range of Motion:
- Flexion and Extension: Assess the wrist’s ability to flex (bend forward) and extend (bend backward). A common technique is asking the patient to perform the "prayer sign" (bringing palms together).
- Ulnar and Radial Deviation: Observe the wrist's capacity to move side-to-side (towards the little finger and thumb respectively).
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Passive Range of Motion:
- Gently move the patient’s wrist through its full range of flexion and extension.
- Note any limitations, pain, or crepitus (grating sound). This assesses the joint’s mechanical ability, independent of muscle strength.
Detailed Examination Points
| Examination Component | Description | How to Perform |
|---|---|---|
| Observation | Look for swelling, redness, deformity, scars, and muscle wasting. | Visually inspect the wrist at rest. |
| Finger Extension | Assess wrist extensor strength. | Patient straightens their fingers against gravity. |
| Fist Formation | Assess wrist flexor strength. | Patient makes a fist. |
| Active Flexion/Extension | Patient moves wrist through its range of flexion and extension. | Ask the patient to perform the “prayer sign”. |
| Passive Flexion/Extension | Gently move the patient’s wrist through its range of motion to assess limitations. | Gently move the patient’s wrist through its range. |
| Radial/Ulnar Deviation | Patient moves wrist from side-to-side | Observe range of motion as the wrist moves towards the thumb and little finger. |
Key Insights for Wrist Examination
- Compare Sides: Always compare findings with the unaffected wrist to establish a baseline.
- Pain Assessment: Ask about pain, its location, and its character during each movement.
- Functional Assessment: Observe how the wrist affects daily tasks and activities.
- Palpation: Gently feel the bones and soft tissues to check for tenderness, swelling, and temperature changes.
By following these steps and guidelines, you can perform a comprehensive and effective examination of the wrist.
