[Clinical examination of the injured wrist]

A highly differentiated clinical examination of the wrist joint has been established in the past years. The history of the accident is usually unreliable, but patient's statement of a hyperflexion injury should alert for a fracture of the scaphoid tubercle. First of all, X-rays of the wrist indicate therapy in the case of fractures and gross dislocations. Only after some days of reduction of pain and swelling, a thorough clinical examination will be possible, which consists of: localizing points of tenderness, in particular the scapho- lunate, lunato-triquetal and the scapho-trapezio-trapezoid (SL-, LT- and STT-) joints and the triangular fibrocartilage (TFC); testing for abnormal dorso-palmar shifts of the carpus and the ulnar head; provoking catch up clunks by radio-ulnar movements of the clenched fist; provoking subluxations, in particular of the scaphoid in Watson's test; provoking pain in the discuss grinding test. Comparing clinical diagnosis with arthroscopic findings in 37 patients, the results for ligamentous lesions in general, SL ligament lesions in particular and for TFC lesions were as follows: sensitivity 100%, 91% and 69%, resp.; specificity 77%, 77% and 67%, resp.; positive predictive values 75%, 62% and 61%, respectively. In conclusion, exact clinical examination is a reliable tool to determine further diagnostics and therapy of wrist injuries.