Chronic Wrist Pain is a challanged to understand. This PPT is a effort to make it bit easy to understand.

2. • Wrist is a complex
Composite joint..
• …probably one of the
most complicated in the
human body...!!!

4. Why do we need such a complicated
Wrist????

10. Chronic wrist pain resulting
from interosseous ligament
injury remains a diagnostic
dilemma for many HAND
surgeons.

16. Systematic Assessment
• The Basic Rules always apply
– Look
– Feel
– Move
– Provocative tests
– Lignocaine injection

17. Feel
• Single most important step in all wrist
conditions
• Anatomical components
– Tendon
– Bone
– Ligament
– Nerve

18. Radial Wrist Pain
• Eichhoff / Finkelstein
• WHAT Test
• Scaphoid Shift (Watson)
• SL Ballottement
• Finger extension test
• 1st CMCJ Grinding

21. WHAT Test
• S Goubou JF et al. The wrist hyperflexion
and abduction of the thumb (WHAT) test:
a more specific and sensitive test to
diagnose de Quervain tenosynovitis than
the Eichhoff's Test. J Hand Surg Eur Vol.
2014 Mar:39(3):286-92

23. Watson Test

29. Ulnar Column

30. Forced Prono-supination
• Well supported elbow, fully relaxed wrist
• Rotate forearm (pure DRUJ)
rather than hand (multi-linked)
• Pain pinpointed to ulnar wrist
No pain = intact DRUJ / peripheral TFCC

31. • Hand and distal radius as single unit
• Test in neutral, pronation and supination
• Apply anterior and posterior stress
• Note translation, pain & clicks
• Compare with unaffected wrist

32. Hagert 1994, Kleinman 2007
Pronation
Superficial dorsal &
Deep palmar taut
Supination
Superficial palmar &
Deep dorsal taut

35. Piano Key Sign

36. LT LIGAMENT INJURY
• LT ligament complex are difficult to diagnose
because x-rays are normal.
• 3 maneuvers that can be of help to diagnose
LT injury.
– Ballotment test
– Shuck sign
– Shear test

37. Ballotment test

38. Shuck sign

39. Shear Test

40. ECU Synergy (Stress) Test

41. THANK YOU