Wrist Orthopaedic Tests
Anterior Aspect
Flexor Tendons
Flexor carpi ulnaris
Palmaris longus
Flexor digitorum profundus
Flexor digitorum superficialis
Flexor pollicis longus
Flexor carpi radialis
Flexor Tendons
Carpal Tunnel
The median nerve and the finger flexion tendons lie
within the carpal tunnel.
This is a common site of compression neuropathy.
Carpal Tunnel
Guyon’s Canal
(Ulnar Tunnel)
The ulnar nerve and artery lie within Guyon’s tunnel.
This is also a common site of compression neuropathy.
Guyon’s Canal
(Ulnar Tunnel)
Posterior Aspect
The ulnar styloid process is at the posterior aspect of
the wrist proximal to the fifth digit.
The radial tubercle is at the posterior aspect of the
wrist proximal to the thumb.
Pain the the tubercle may indicate Colle’s fracture.
Pain at the ulnar styloid process may indicate a distal
ulnar fracture.
Ulnar Styloid Process and
Radial Tubercle
Posterior Aspect
There are six fibro-osseous tunnels at the posterior
aspect of the wrist.
The extensor tendons to the hand pass through these
tunnels.
They are bound by an extensor retinaculum
superficially.
Extensor Tendons
Tunnels and associated tendons
Tunnel 1 Adductor pollicis longus, extensor pollicis
brevis
Tunnel 2 Extensor carpi radialis longus and brevis
Tunnel 3 Extensor pollicis longus
Tunnel 4 Extensor digitorum and extensor indexes
Tunnel 5 Extensor digiti minimi
Tunnel 6 Extensor carpi ulnaris
Extensor Tendons
Carpal Tunnel Syndrome
Carpal tunnel syndrome is a compression neuropathy
of the median nerve.
Compression occurs under the flexor retinaculum at
the wrist.
Carpal Tunnel Syndrome
Carpal Tunnel Syndrome
Clinical Signs and Symptoms
Loss of sensation of the tips of the first three fingers
Hand and wrist pain
Weakness of grip
Tinel’s Wrist Sign
Procedure: Patient’s hand supinated. Stabilize the
wrist with one hand. With your opposite hand, tap
the palmar surface of the wrist with a neurological
reflex hammer.
Rationale: Tingling along the distribution of the
medial nerve indicates carpal tunnel syndrome. The
cause could be any of the following: inflammation of
the flexor retinaculum, anterior dislocation of the
lunate bone, arthritic changes, or tenosynovitis of the
flexor digitorum tendons.
Tinel’s Wrist Sign
Phalen’s Test
Procedure: Flex both wrist and approximate them
towards each other. Hold for 60 seconds.
Rationale: When both wrists are flexed, the flexor
retinaculum provides increased compression of the
medial nerve in the carpal tunnel. Tingling in the
distribution of the median nerve (thumb, index finger,
middle finger, and medial half of ring finger) indicates
carpal tunnel syndrome.
Phalen’s Test
Reverse Phalen’s Test
Procedure: Instruct the patient to extend the affected
wrist and have him grip your hand. With your
opposite thumb, press on the carpal tunnel.
Rationale: Extending the hand and providing pressure
over the carpal tunnel further constricts the tunnel.
Tingling may indicate compression of the medial
nerve.
Reverse Phalen’s Test
Ulnar Tunnel Syndrome
The ulnar nerve travels through the tunnel of Guyon
and innervates the muscles of the little and ring
fingers.
Ulnar nerve syndrome is a compression neuropathy of
the ulnar nerve.
Guyon’s Canal (Ulnar Tunnel)
Ulnar Tunnel Syndrome
Clinical Signs and Symptoms
Pain over the little and ring finger
Weakness of grip
Difficulty with finger spreading
Claw hand
Ulnar Tunnel Triad
Procedure: Inspect and palpate the patient’s wrist,
looking for tenderness over the ulnar tunnel, clawing
of the ring finger, and hypothenar wasting.
Rationale: All of these signs are indicative of ulnar
nerve compression possibly in the tunnel of Guyon.
Ulnar Tunnel Triad
Stenosing Tenosynovitis
Stenosing tenosynovitis in the wrist affects the tendon
and sheath of the abductor pollicis longus and extensor
pollicis brevis.
It is also termed de Quervain’s or Hoffman’s disease.
Swelling of the tendons and thickening of the sheaths
that they pass through is due to an overuse condition
of the wrist and thumb.
Stenosing Tenosynovitis
Clinical Signs and Symptoms
Painful wrist and thumb during movement
Swelling over the radial styloid
Tendons and sheath tender to palpation
Stenosing Tenosynovitis
Finkelstein’s Test
Procedure: Instruct the patient to make a fist with the
thumb across the palmar surface of the hand and to
stress the wrist medially.
Rationale: Making a fist and stressing it medially will
stress the abductor pollicis longus and extensor pollicis
brevis tendons. Pain in the distal styloid process of the
radius indicates stenosing tenosynovitis of the tendons
(de Quervain’s disease).
Finkelstein’s Test