CLINICAL EXAMINATION OF THE WRIST

A systematic and reproducible wrist examination is essential for identifying patterns of injury, differentiating ligamentous from bony pathology, and selecting appropriate special tests. As with other upper-limb joints, many clinicians find that the Look–Move–Feel sequence flows more naturally when “Move” precedes “Feel,” allowing tenderness findings to guide targeted special tests.

1. LOOK

Inspect both wrists, comparing sides.

General Inspection

Symmetry of wrist contour

Swelling (global, dorsal, volar, radial or ulnar-sided)

Deformity

Dorsal swelling → possible scapholunate (SL) pathology

Ulnar-sided fullness → TFCC or DRUJ pathology

Muscle wasting

Thenar eminence

Hypothenar eminence

Interossei

Skin changes

Bruising

Scars (previous surgery)

Sinuses or puncture wounds

Hand posture

Finger cascade

Attitude suggestive of carpal instability

Palmar and Dorsal Aspect

Palmar: thenar eminence, carpal tunnel area

Dorsal: Lister’s tubercle, scapholunate interval

2. MOVE

Assess active first, then passive, comparing both sides.

Range of Motion

Dorsiflexion (extension)

Ask patient to place palms together and lift elbows upward (“prayer test”).

Palmarflexion

Place dorsum of hands together and lower elbows downward (“reverse prayer”).

Radial deviation

Ulnar deviation

Pronation

Supination

Both elbows tucked in to the side to eliminate shoulder rotation.

Observe for:

Pain

Restriction

Asymmetry

Clunking or instability


3. FEEL

Identify tender landmarks systematically.

Palpation

Distal radius and ulna

Lister’s tubercle

Key landmark just proximal to the scapholunate ligament

Snuffbox (scaphoid)

Scapholunate interval

Lunotriquetral interval

TFCC region (ulnar fovea)

Pisiform and hamate hook

DRUJ for crepitus or instability

Tenderness in specific areas should direct the choice of Special Tests.

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  • 4. SPECIAL TESTS
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  • Select tests based on anatomical suspicion from palpation.
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  • A. Scapholunate (SL) Ligament Injury
  • Tenderness over SL Ligament → Perform Watson (Scaphoid Shift) Test
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  • Kirk Watson Test
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  • Examiner stabilises the scaphoid volarly with thumb pressure.
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  • Wrist is moved from ulnar deviation + extension → radial deviation + flexion.
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  • Positive test:
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  • Palpable clunk or pain
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  • Suggests scapholunate instability.
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  • B. Lunotriquetral (LT) Ligament Injury
  • Tenderness over LT interval → Perform LT Ballottement Test
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  • LT Ballottement (Reagan) Test
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  • Stabilise the lunate between thumb and index finger of one hand.
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  • With the other hand, grasp the triquetrum and pisiform.
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  • Apply a volar–dorsal “pistoning” motion.
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  • Positive test:
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  • Pain
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  • Excessive movement
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  • Crepitus
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  • Suggests lunotriquetral instability.
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  • C. TFCC Injury / DRUJ Pathology
  • Ulnar-sided tenderness → Perform TFCC Grind Test
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  • TFCC Grind Test
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  • Ulnar deviation of the wrist with axial load.
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  • Forearm rotated (pronation–supination).
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  • Positive test:
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  • Pain
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  • Clicking
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  • Suggests TFCC tear or DRUJ pathology.
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  • D. Additional Useful Tests (Optional for Completeness)
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  • Fovea Sign – tenderness between the ulnar styloid and FCU tendon → TFCC tear.
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  • Piano Key Test – dorsal prominence of distal ulna with rebound → DRUJ instability.
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  • Shuck Test – midcarpal instability.