A comprehensive clinical examination is the basis for selecting further diagnostic steps:
- General physical examination – including blood pressure, pulse, body weight, height; further:
- Inspection (viewing).
- Palpation (palpation) of prominent bone points, tendons, ligaments; musculature; joint (joint effusion); soft tissue swelling; tenderness (localization!).
- Measurement of joint mobility and range of motion of the affected joint(s) (according to the neutral zero method: range of motion is given as the maximum deflection of the joint from the neutral position in angular degrees, with the neutral position designated as 0°. The starting position is the “neutral position”: the person stands upright with the arms hanging down and relaxed, the thumbs pointing forward and the feet parallel. The adjacent angles are defined as the zero position. Standard is that the value away from the body is given first).
- Palmar flexion (bending of the hand towards the palm) and dorsal extension (extension of the hand towards the back of the hand).
- Radial abduction (lateral displacement of the hand in the direction of the radius) and ulnar abduction (lateral displacement of the hand in the direction of the ulna).
- Pronation (inward rotation of the hand) and supination (outward rotation of the hand) with comparison of the opposite side.
- Functional tests:
- Finkelstein test: during jerky passive ulnar abduction (lateral displacement (abduction) of the hand or fingers in the direction of the ulna (ulna)) with the thumb flexed and the fist closed, pain occurs in the first extensor tendon compartment. This results in constriction of the tendon of the extensor pollicis brevis muscle (Latin for “short thumb extensor”) and thus pain over the styloid process (stylar process of the radius). A positive test result is pathognomonic (disease characteristic) for tendovaginitis stenosans de Quervain (Quervain’s tendovaginitis).
- DRUG stability testing (distal radio-ulnar joint, (DRUG) stability testing): The examiner fixes the radius (radius) and carpus (carpus located between the wrist (articulatio radiocarpalis) of the forearm and the metacarpal) with one hand, and the other hand almost fixes the ulna (ulna) between the index finger and thumb. Then there is a translational movement between the ulna and the radius in the dorsopalmar direction (positional designation, looking from the back of the hand toward the palm). The comparison of the possible translation in neutral position, radial abduction (movement in which the hand is bent in the direction of the radius (radius), that is, to the side of the thumb), pronation and supination in the side comparison provides information about the stability in the DRUG.
- Watson test (checking the stability of the scapholunate ligament, (SL ligament); this stretches out between the scaphoid (Os scpaphoideum or scaphoid) and lunate): The examiner presses on the distal-palmar tubercle of the scaphoid with the thumb while passively guiding the wrist from radial (radius/spoke) to ulnar (ulna/ ulna). In the case of higher grade damage to the SL ligament, in addition to pain, there is a “snapping” (palpable) of the proximal scaphoid pole over the dorsal radial lip during radial adduction. Lateral comparison provides information about a possible SL ligament rupture (ligament tear).
- Assessment of blood flow, motor function and sensitivity:
- Circulation (palpation of pulses).
- Motor function: testing of gross strength in lateral comparison.
- Sensibility (neurological examination) [paresthesias (sensory disturbances) and numbness].
Square brackets [ ] indicate possible pathological (pathological) physical findings.
