Clinical Assessment

An individual's age affects the maturity of the bones and influences the type of injury. Children are more likely to sustain injuries to the immature, weaker epiphyseal plate or metaphysis of the radius. Their carpus is mostly cartilage that helps cushion them from injury. Carpal injuries are rare in children. Young adults, particularly those with active lifestyles, are more likely to be injured with greater force and disrupt either the carpus or distal radial metaphysis that often involves the articular surface. In the elderly, the weak point is the brittle distal radial metaphysis.

Injuries most often occur from falls on the outstretched hand. Impact on the thenar eminence is more likely to injure the scaphoid and its supporting ligaments. An impact on the hypothenar eminence is likely to cause injury to the triquetrum and the pisiform, and to their supporting ligaments.

Pinpointing areas of tenderness and correlating it to anatomical landmarks on the wrist will help determine what structure may be injured and the best way to evaluate it with a radiograph. The most noteworthy landmark on the dorsum of the wrist is the anatomical snuffbox. The scaphoid is palpable at the base of this triangle and the radial styloid forms its proximal base. The extensor pollicis longus creates the ulnar border of the snuffbox, as it wraps around Lister's tubercle, a palpable small bony prominence on the distal radius. The scapholunate joint is located just distal to Lister's tubercle. Immediately ulnar to the scapholunate junction is a palpable indentation in the middle of the wrist that is the location of the lunate and capitate. When the wrist is flexed, the lunate is palpable as it rises out of this fossa. The ulnar styloid is the bony prominence on the ulnar aspect of the wrist. The triquetrum and triangular fibrocartilage complex are located just distal to it.

A clearly visible landmark on the volar aspect of the wrist is the wrist crease that marks the location of the proximal carpal row. The scaphotrapezium joint is palpable at the base of the thenar eminence. The pisiform is the visible bony prominence at the base the hypothenar eminence. The hook of the hamate is palpable within the soft tissue of the hypothenar eminence a centimeter away, at a 45-degree angle radial from the pisiform.

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