Approach
It is important to follow the same approach every time so that nothing is missed. It is suggested to work proximal to distal for all physical examinations. The entire arm should be exposed for observation and inspection. Although the patient has a wrist injury, the elbow and shoulder region should also be evaluated to eliminate items on the differential. First observe the position of the wrist, hand, and fingers noting obvious deformities and general presentation. If swelling is present the patient may not be able to fully extend the wrist, supporting it in a flexed position. Also note the contour and posture of the hand.Inspection of the dorsal and volar surfaces respectively.
Image Source: Victoria Squissato
Findings,
- Deformity, ganglion
- Swelling
- Discolouration
- Muscle atrophy (Thenar)
- Scars
It is also important to observe the patient's posture. Findings,
Forward-head and rounded-shoulder postures.
Image Source: Victoria Squissato
Wartenberg Sign: the little finger gets caught on the edge of a patient’s pocket when the patient attempts to put her hands into her pants pocket.
Image Source: Victoria Squissato
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