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Wrist Assessment Form

WRIST ASSESSMENT

NameDateSubjective HistoryPresent Condition / Perceived Main Problem:

Dominance: Left Right Ambidextrous

Injured Side: Left Right

Where did the injury occur: Home Sport Work Other

Pain VAS:Previous Investigations:

Past Medical History Asthma Diabetes Past History of Cancer Epilepsy Thyroid Issues Blood Pressure Heart Issues

Red Flags Trauma Constant Non-Mechanical Pain Thoracic Pain Structural Deformity Hot / swollen joints Suspected Scaphoid Fracture Systemic Steroids Weight Loss Drug Abuse Past History of Cancer TB / HIV Systemically unwell Widespread Neurological Changes Marked Neurological Deterioration

Observations:

Wrist Assessment: Dorsal & Volar Structure Palpation

Dorsal Structure Palpation Assessment of Injured Side. Mark if positive. 1st Dorsal Compartment 1st CMCJ Radial Styloid Lister's Tubercle Scaphoid Scapho-Lunate Joint Line Lunate DRUJ Luno-Triquetral Joint Line Triquetrum Ulnar Head TFCC ECU CMC Joints 2-5 Scapho-Trapezial Joint Trapezium DRS Nerve EDC ECRL/B

Volar Structure Palpation Assessment of Injured Side. Mark if positive. Pisiform Hook of Hamate Scaphoid Tuberosity Radio-Scaphoid Ligament Beak Ligament FCR FCU Capitate Scaphoid Waist

Notes / Comments on Palpation

Specific Wrist Structure Tests - Mark if positive for the injured side Scaphoid Shift Left Scaphoid Shift Right TFCC Left TFCC Right DRUJ Instability Left DRUJ Instability Right Mid Carpal Sift Left Mid Carpal Shift Right Middle Finger Extension Left Middle Finger Extension Right ECU Subluxation Left ECU Subluxation Right Finklestein Left Finklestein Right

Comments on Specific Tests

Is Kienbock's disease a consideration? Yes No

Is a Ganglion or concerning lump or bump (potentially a tumour) a consideration? Yes No

Power Testing: Shoulder, Elbow, Wrist & Hand

Mark if shoulder strength is less than Grade 5 Pectorals: Shoulder Abduction Posterior Deltoid: Shoulder Adduction

Comment on Bilateral Testing

Mark if elbow is less than Grade 5 Biceps: Flexion Triceps: Extension Infraspinatus: External Rotation

Comment on Bilateral Testing

Mark if wrist is less than Grade 5 ECU: Extend and ulnar deviate the wrist ECR: Wrist Extension FCR: Wrist Flexion

Comment on Bilateral Testing

Mark if hand is less than Grade 5 Extrinsics with slight wrist flexion to avoid tenodesis effect FPL FDP II FDP V APB ADM

Comment on Bilateral Testing

Dynamometer Grip Strength Testing

Grip Strength Left / Right in NeutralGrip Strength Left / Right in PronationGrip Strength Left / Right in Supination

AROM Goniometer Testing

Wrist AROM Left Flex / Ext Wrist AROM Right Flex / Ext Wrist AROM Left RD / UDWrist AROM Right RD / UDWrist AROM Left Pronation / SupinationWrist AROM Right Pronation / Supination

Test Strength / Power in the Presence of: Numbness, Upper Extremity Ache or Pain, Loss of Endurance or Dexterity.

Consider Lacertus Syndrome: ( Proximal Median Nerve Compression). Mark if the following strength tests are less than Grade 5 FPL FDP2 FCR Pos Lacerates (All 3 above are marked)

Consider Cubital Tunnel: Mark is less than Grade 5 FDP V Weakness

Consider Guyon's Canal Weakness: Mark is less than Grade 5 ADM Weakness

Provisional Diagnosis

Management Plan Refer for NCS Refer for X-Ray Refer to Specialist Begin Hand Therapy Splint

Specifics on Management Plan

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