Wrist Orthopaedic Tests

Anterior Aspect

Flexor TendonsFlexor 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 tendonsTunnel 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 SymptomsLoss 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 SymptomsPain 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 SymptomsPainful 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