Wrist/Hand Examination and Common Conditions

09/07/2026

Compartment 1 Muscles

Extensor Pollicis Brevis

Abductor Pollicis Longus

Which compartment of the wrist is involved with DeQuervain’s Tenosynovitis?

Compartment 1

Triangular Fibrocartilage Complex (TFCC) Defn

Approximates the distal radius and ulna with the carpal bones

Supported by the Ulnolunate/Ulnotriquetral, Ulnar Collateral, and Radioulnar Ligaments

Contains an articular disc homologous to the meniscus of the knee that is concave on both the superior and inferior surfaces

Triangular Fibrocartilage Complex (TFCC) MOI

Functionally absorbs 20% of compression/loading at the wrist

FOOSH/FOOA with supination or chronic rotational loading (racquet sports)

Triangular Fibrocartilage Complex (TFCC) Signs and Symptoms

P1 = medial wrist at distal ulna; TTP @ dorsal depression

Agg. = forceful gripping, end-range sup/pon; passive supination with ulnar dev.

May report painful clicking that may be recreated with movement of carpals into ulnar dev.

Imaging may reveal positive ulnar variance

Ulnar Variance

The measurable difference between the lengths of the radius and ulna at the Distal Radioulnar Joint (DRUJ)

Plain-film radiograph paired with lines crossing at the base of the articular surface of the radius, with one line following the long axis of the radius and the other as the reference for radial and ulnar length.

Neutral Ulnar Variance

Radius = Ulna

Negative Ulnar Variance

Radius > Ulna

Positive Ulnar Variance

Radius < Ulna

May predispose an individual to TFCC injury due to increased compressive load with ulnar deviation.

Triangular Fibrocartilage Complex (TFCC) Management

Goal: reduce stress on TFCC for recovery

Interventions:

• long arm cast or splint for 6 weeks

  • elbow flex 90 deg

  • wrist UD and ext

• Proximal strengthening

• After cast removal, begin A/AAROM for flex/ext » pron/sup » RD/UD

  • ~2wks post-cast may begin progressive strengthening if asymptomatic

Caution: torsion forces are the most stressful on the TFCC

Types of Wrist Instability

1. Dissociative
   dorsal intercalated segmental instability (DISI)
   ventral intercalated segmental instability (VISI)

2. Non-dissociative

Dorsal Intercalated Segmental Instability (DISI) Defn

Most common dissociated instability = scapholunate instability, also known as scapholunate advanced collapse (SLAC wrist)

Lunate migrates dorsally as scaphoid flexes with wrist.

Dorsal Intercalated Segmental Instability (DISI) MOI

FOOSH/FOOA with wrist ext and UD

Injury to the scapholunate ligament

Dorsal Intercalated Segmental Instability (DISI) Signs and Symptoms

P1 = chronic, vague pain and weakness with grip

TTP at scaphoid and/or lunate

Laxity with mobility testing at scapholunate articulation

(+) Wason’s Scaphoid Shift = “clunk” » moving between ext/RD and flex/UD

Watson’s Scaphoid Shift Test

Palpate the scaphoid tubercle with your thumb.

Passively ulnarly deviate the wrist.

Maintain scaphoid pressure and move into radial deviation.

(+) clunk and concordant pain; may also produce click with release of pressure

Dorsal Intercalated Segmental Instability (DISI) Management

Conservative: 2wks immobilization with splint or cast

If conservative fails or ligament injury too severe: scapholunate ligament repair via dorsal capsulodesis (takes flap of dorsal capsule and immobilizes the scaphoid and lunate to prevent instability; flap attached with Tacit anchors)

Ventral Intercalated Segmental Instability (VISI) Defn

Second most common dissociated instability = lunotriquetral instability

• however, MUCH less common than DISI

Ventral tilt of the distal lunate; lunate is tethered to scaphoid

Ventral Intercalated Segmental Instability (VISI) MOI

FOOSH/FOOA with wrist ext and RD

Injury to the lunotriquetral ligament

Ventral Intercalated Segmental Instability (VISI) Signs and Symptoms

Similar to DISI:

P1 = chronic, vague pain and weakness with grip

TTP at lunate or triquetrum; may reproduce P1 with shear forces at lunotriquetral articulation

Laxity with mobility testing at lunotriquetral articulation

Non-dissociative Instability Defn

Most common dynamic instability at the wrist

Insufficiency of dorsal intercarpal ligaments

Common in gymnasts due to repetitive, heavy closed-chain load

Non-dissociative Instability Signs and Symptoms

May be asymptomatic; volitional subluxation and reduction

“clunk” may be present with reduction

Non-dissociative Instability Management

Conservative: splint or cast for 2 weeks

If conservative fails: surgical repair

Carpal Tunnel Syndrome Defn

Ischemic compression of the median nerve due to increased carpal tunnel pressure from synovial fluid, tendon tension, or stenosis

Often associated with OA of the wrist

Prevalence: 3.7%

• Men = 0.6%

• Women = 9.2%

Carpal Tunnel Syndrome MOI

May be related to:

• pregnancy, renal dysfunction, infection

• gout, pseudogout, acromegaly, amyotrophy