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Clinical Examination of the Ulnar-Sided Painful Wrist

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Book cover Arthroscopic Management of Ulnar Pain

Abstract

Ulnar-sided wrist pain is a challenging clinical condition, difficult to manage. It may result from intracapsular injury or from pathology outside the capsule. Arthroscopy may help solving the first, but it has little to offer to assess most extracapsular problems. To facilitate making a diagnosis, a thorough clinical examination is recommended. In fact, the better the clinical examination, the narrower the list of potential diagnoses will be. Obviously, this will imply ordering less imaging techniques to confirm the diagnosis, and the entire diagnostic process will be cheaper. Wrist examination consists of palpation, measurement of motion and grip strength, passive joint mobilization, and provocative tests. This chapter will provide a step-by-step description of the tests and maneuvers that may be used to identify the source of the patient’s complaints.

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References

  1. Adams BD, Berger RA (2002) An anatomic reconstruction of the radioulnar ligaments for posttraumatic distal radioulnar joint instability. J Hand Surg Am 27:243–251

    Article  PubMed  Google Scholar 

  2. Ambrose L, Posner M (1992) Lunate-triquetral and midcarpal joint instability. Hand Clin 8:653–668

    PubMed  CAS  Google Scholar 

  3. Beckenbaugh RD (1984) Accurate evaluation and management of the painful wrist following injury. Orthop Clin North Am 15:289–306

    PubMed  CAS  Google Scholar 

  4. Bell SJ, Hofmeister EP, Moran SL, Shin AY (2007) The diagnostic utility of midcarpal anesthetic injection in the evaluation of chronic wrist pain. Hand 2:39–45

    Article  PubMed  Google Scholar 

  5. Berger RA, Dobyns JH (1996) Physical examination and provocative maneuvers of the wrist. In: Gilula LA, Yin Y (eds) Imaging of the wrist and hand. WB Saunders, Philadelphia

    Google Scholar 

  6. Burkhart SS, Wood MB, Linscheid RL (1982) Posttraumatic recurrent subluxation of the extensor carpi ulnaris tendon. J Hand Surg Am 7:1–3

    PubMed  CAS  Google Scholar 

  7. Buck FM, Gheno R, Nico MA et al (2009) Ulnomeniscal homologue of the wrist: correlation of anatomic and MR imaging findings. Radiology 253:771–779

    Article  PubMed  Google Scholar 

  8. Christodoulou L, Bainbridge LC (1999) Clinical diagnosis of triquetrolunate ligament injuries. J Hand Surg Br 24:598–600

    Article  PubMed  CAS  Google Scholar 

  9. Cooney WP, Bishop AT, Linscheid RL (1997) Physical examination of the wrist. In: Cooney WP, Dobyns JH, Linscheid RL (eds) The wrist: diagnosis and operative treatment. Mosby, St. Louis

    Google Scholar 

  10. Feinstein WK, Lichtman DM, Nobel PC et al (1999) Quantitative assessment of the midcarpal shift test. J Hand Surg Am 24:977–983

    Article  PubMed  CAS  Google Scholar 

  11. Garcia-Elias M (1998) Soft-tissue anatomy and relationships about the distal ulna. Hand Clin 14:165–176

    PubMed  CAS  Google Scholar 

  12. Garcia-Elias M (2008) The non-dissociative clunking wrist: a personal view. J Hand Surg Eur 33:698–711

    CAS  Google Scholar 

  13. Garcia-Elias M, Lluch AL, Ferreres A et al (2008) Transverse loaded prono-supination test. J Hand Surg Eur 33:765–767

    CAS  Google Scholar 

  14. Gross SC, Watson HK, Strickland JW et al (1989) Triquetral-lunate arthritis secondary to synostosis. J Hand Surg Am 14:95–102

    Article  PubMed  CAS  Google Scholar 

  15. Helal B (1978) Racquet player’s pisiform. Hand 10:87–90

    Article  PubMed  CAS  Google Scholar 

  16. Hertling D, Kessler RM (1990) Management of common musculoskeletal disorders: physical therapy principles and methods. JB Lippincott, Philadelphia

    Google Scholar 

  17. Johnson RP, Carrera GF (1986) Chronic capitolunate instability. J Bone Joint Surg Am 68:1164–1175

    PubMed  CAS  Google Scholar 

  18. Kalainov DM, Hartigan BJ, Cohen MS (2004) Lunotriquetral instability: clinical findings. Atlas Hand Clin 9:17–24

    Article  Google Scholar 

  19. Kleinman WB (2007) Stability of the distal radioulnar joint: biomechanics, pathophysiology, physical diagnosis, and restoration of function; what we have learned in 25 years. J Hand Surg Am 32:1086–1106

    Article  PubMed  Google Scholar 

  20. LaStayo P, Weiss S (2001) The GRIT: a quantitative measure of ulnar impaction syndrome. J Hand Ther 14:173–179

    Article  PubMed  CAS  Google Scholar 

  21. LaStayo PC, Howell J (1995) Clinical provocative tests used in evaluating wrist pain: a descriptive study. J Hand Ther 8:10–17

    Article  PubMed  CAS  Google Scholar 

  22. Lee M, LaStayo PC (2011) Ulnar wrist pain and impairment: a therapist’s algorithmic approach to the triangular fibrocartilage complex. In: Skirven TM, Osterman AL, Fedorczyk J et al (eds) Rehabilitation of the hand and upper extremity, 6th edn. Elsevier, Philadelphia

    Google Scholar 

  23. Lester B, Halbrecht J, Levy IM et al (1995) “Press test” for office diagnosis of triangular fibrocartilage complex tears of the wrist. Ann Plast Surg 35:41–45

    Article  PubMed  CAS  Google Scholar 

  24. Lichtman DM, Schneider JR, Swafford AR, Mack GR (1981) Ulnar midcarpal instability-clinical and laboratory analysis. J Hand Surg 6:515–523

    CAS  Google Scholar 

  25. Linscheid RL, Dobyns JH (1985) Athletic injuries of the wrist. Clin Orthop Relat Res 188:141–151

    Google Scholar 

  26. Louis DS, Hankin FM, Greene TL et al (1984) Central carpal instability – capitate lunate instability pattern. Diagnosis by dynamic displacement. Orthopedics 7:1693–1696

    Google Scholar 

  27. Morrissy RT, Nalebuff EA (1979) Dislocation of the distal radioulnar joint: anatomy and clues to prompt diagnosis. Clin Orthop Relat Res 144:154–158

    PubMed  Google Scholar 

  28. Nakamura R, Horii E, Imaeda T et al (1997) The ulnocarpal stress test in the diagnosis of ulnar-sided wrist pain. J Hand Surg Br 22:719–723

    Article  PubMed  CAS  Google Scholar 

  29. Nelson DL (1997) Additional thoughts on the physical examination of the wrist. Hand Clin 13:35–37

    PubMed  CAS  Google Scholar 

  30. Nishikawa S, Toh S, Miura H, Arai K (2002) The carpal detachment injury of the triangular fibrocartilage complex. J Hand Surg Br 27:86–89

    PubMed  CAS  Google Scholar 

  31. Raskin KB, Beldner S (1998) Clinical examination of the distal ulna and surrounding structures. Hand Clin 14:177–190

    PubMed  CAS  Google Scholar 

  32. Reagan DS, Linscheid RL, Dobyns JH (1984) Lunotriquetral sprains. J Hand Surg Am 9:502–514

    PubMed  CAS  Google Scholar 

  33. Ruland RT, Hogan CJ (2008) The ECU synergy test: an aid to diagnose ECU tendonitis. J Hand Surg Am 33:1777–1782

    Article  PubMed  Google Scholar 

  34. Sanz L, Dias R, Heras-Palou C (2009) A modification of the ballottement test in the assessment of the distal radioulnar joint instability. J Bone Joint Surg Br 91(Suppl I):80

    Google Scholar 

  35. Schernberg F (1990) Roentgenographic examination of the wrist: a systematic study of the normal, lax and injured wrist. J Hand Surg Br 15:210–228

    PubMed  CAS  Google Scholar 

  36. Shaaban H, Giakas G, Bolton M et al (2004) The distal radioulnar joint as a load-bearing mechanism- a biomechanical study. J Hand Surg Am 29:85–95

    Article  PubMed  Google Scholar 

  37. Shin AY, Deitch MA, Sachar K et al (2005) Ulnar-sided wrist pain: diagnosis and treatment. Instr Course Lect 54:115–128

    PubMed  Google Scholar 

  38. Tay SC, Tomita K, Berger RA (2007) The “ulnar fovea sign” for defining ulnar wrist pain: an analysis of sensitivity and specificity. J Hand Surg Am 32:438–444

    Article  PubMed  Google Scholar 

  39. Thurston AJ, Stanley JK (2000) Hamato-lunate impingement: an uncommon cause of ulnar-sided wrist pain. Arthroscopy 16:540–544

    Article  PubMed  CAS  Google Scholar 

  40. Topper SM, Wood MB, Ruby LK (1997) Ulnar styloid impaction syndrome. J Hand Surg Am 22:699–704

    Article  PubMed  CAS  Google Scholar 

  41. Watson HK, Weinzweig J (1997) Physical examination of the wrist. Hand Clin 13:17–34

    PubMed  CAS  Google Scholar 

  42. Weinzweig J, Watson HK (1999) Triquetral impaction ligament tear (TILT). J Hand Surg Br 24:321–324

    Article  PubMed  Google Scholar 

  43. Wright TW, Moser MW, Sahajpal DT (2010) Hook of the hamate pull test. J Hand Surg Am 35:1887–1889

    Article  PubMed  Google Scholar 

  44. Young D, Papp S, Giachino A (2007) Physical examination of the wrist. Orthop Clin North Am 38:149–165

    Article  PubMed  Google Scholar 

  45. Zancolli ER 3rd (2001) Localized medial triquetral-hamate instability: anatomy and operative reconstruction-augmentation. Hand Clin 17:83–96

    PubMed  Google Scholar 

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Correspondence to Marc Garcia-Elias M.D., Ph.D. .

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© 2012 Springer-Verlag Berlin Heidelberg

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Garcia-Elias, M. (2012). Clinical Examination of the Ulnar-Sided Painful Wrist. In: del Piñal, F. (eds) Arthroscopic Management of Ulnar Pain. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-30544-3_3

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  • DOI: https://doi.org/10.1007/978-3-642-30544-3_3

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  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-30543-6

  • Online ISBN: 978-3-642-30544-3

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