Physical Examination
A physical exam is also essential to diagnose wrist pain. It should include cardiovascular examinations, a neurologic test, and sometimes an evaluation of the integrity of the spinal column, the neck, and the upper extremity. This type of exam is particularly important if you have symptoms such as radiated pain, numbness, and tingling, and one of the goals is to rule out a herniated cervical disc and nerve entrapment syndromes.
Visualization and palpation can identify swelling, redness, changes in volume, cysts, and other masses. The latter is also useful for identifying tenderness and guarding, which are often indicative of a mechanical cause of wrist pain. Comparing both wrists and their symptoms is also an important part of the physical exam. Doctors will evaluate active and passive range of motion, including flexion, extension, radial deviation, ulnar deviation, pronation, and supination. To do so, they will ask you to move your hands in different ways.
There are also different maneuvers doctors can apply. For instance:
- In the Finkelstein test, doctors grasp your thumb and then deviate the ulna to the wrist. Quervain’s tenosynovitis is a likely diagnosis if this motion triggers pain in the radius.
- The grind test, which has at least two subtypes. It can be done by compressing and rotating the distal radioulnar joint or the metacarpal bone. If your doctor finds crepitus and the test causes pain, it would suggest wrist instability and arthritis.
- The supination lift test, in which doctors will ask you to lift with your palm flat on the examination table. That is done to evaluate weakness and pain, which suggest an injury in the triangular fibrocartilage complex.