Location of pain
Trauma to cervical spine, shoulder, elbow, and forearm can radiate symptoms into wrist and hand.
Mechanism of injury
Relevant sounds or sensations
Trigger finger (fractures, dislocations, tendon injuries)
;may have associated popping sound that is accompanied by a sensation of snapping
Duration of symptoms
Nagging wrist pain that does not decrease in severity may indicate scaphoid fracture or
tear of triangular fibrocartilaginous complex (TFCC).
Description of symptoms
"Aching" or "throbbing" indicate bony or soft tissue damages.
"Burning" or "tingling" indicate neurologic or vascular disorders
Previous history
General medical health
Systemic diseases (rheumatoid arthritis) affect the fingers before the other joints in the body.
Peripheral vascular disease (PVD)
A syndrome involving an insufficiency of arteries or veins in maintaining proper circulation
Raynaud's phenomenon
A reaction to cold consisting of boute of pallor and cyanosis, causing exaggerated vasomotor responses.
Inspection
General Inspection
Posturing of the hand; (Slight flexion, with slight arch in palm. Absence of this arch may indicate
avulsion of one or more finger flexor or atrophy of hands intrinsic muscles in case of chronic injuries)
Gross deformity
A fracture of metacarpal shows as protrusion or sepression along the usually flat dorsal surface of the hand.
Palmar creases
Areas of cuts or scars
Russell's sign can be one of the few outward signs of bulimia
Wrist and hand
Continuity of the distal radius and ulna
A loss of continuity may indicate a fracture
Continuity of the carpals and metacarpals
The lunate's abnormal contour may indicate dislocation.
Alignment of the knuckle (MCP joints)
A depressed or shortened knuckle may indicate a metacarpal fracture.
Posture of the wrist and hands
Ganglion cyst
When cyst becomes symptomatic, pain is caused by motion and ganglion is tender to touch and harden with time
Thumb and fingers
Skin and fingernails
Subungual hematoma
Felon
Paronychia
Alignment of fingernails
A finger that deviates from rest may indicate a spinal fracture of a phalanx or metacarpal.
Finger deformities
Boutonniere deformity (Rupture of central extensor tendon)
Mallet finger (Avulsion of extension digitorum longus tendon)
Jersey deformity (Avulsion of flexor digitorum profundus tendon)
Palpation
Palpation of the Hand
Metacarpals
MCP collateral ligaments
Phalanges
IP collateral ligaments
Thenar compartment
Thenar webspace
Central compartment
Hypothenar compartment
Ulna
Ulnar styloid process
Ulnar collateral ligament
Radius
Radial styloid process
Lister’s tubercle
Radial collateral ligament
Palpation of the Carpals
Scaphoid
Trapezium (between scaphoid bone and thumb’s metacarpal)
Lunate
Triquetrum (most proximal aspect of hand one finger’s breadth distal to the ulnar styloid process)
Pisiform
Hamante
Capitate
Trapezoid
Range of Motion Tests
Wrist AROM/PROM/RROM
Flexion, extension, radial deviation, ulnar deviation
Thumb – CMC AROM/PROM/RROM
Flexion, extension, abduction, adduction, opposition
Fingers AROM/PROM/RROM
Flexion, extension, abduction, adduction, Grip dynamometry
Ligamentous Tests
Valgus stress testing – radiocarpal joint
Varus stress testing – radiocarpal joint
Glide testing of the wrist
Valgus stress testing – IP joints
Varus stress testing – IP joints
Ulnar collateral ligament – thumb
Neurologic Tests
Radial nerve
Median nerve
Ulnar nerve
Special Tests
Carpal Tunnel Syndrome
Phalen’s test
DeQuervain’s Syndrome
Finkelstein test