Clinical gems for assessing wrist injuries in athletes

When it comes to assessing athletes, the wrist is one of the most challenging joints to evaluate due to its complexity, and the demands placed on it by high-force sports like gymnastics or repetitive throwing. Accurate diagnosis and effective rehabilitation hinge on understanding the wrist’s biomechanics and functional capacity. Expert physio Ian Gatt offers invaluable insights in his latest Practical, where he shares key strategies for assessing wrist injuries. In this blog, we’ll break down these strategies, helping you refine your clinical skills and enhance your approach to wrist assessments. Ready to improve your practice? Let’s dive in!

If you’d like to see exactly how expert physio Ian Gatt assesses wrist injuries, watch his full Practical HERE. With Practicals, you can be a fly on the wall and see exactly how top experts assess and treat specific conditions – so you can become a better clinician, faster. Learn more here.

Understanding the patient’s narrative

Ian highlights the critical importance of understanding the athlete’s story. Is the wrist injury acute or chronic? Has it happened before, and what treatments have been tried? Understanding the athlete’s sport and future events—like upcoming competitions—also plays a role in tailoring treatment. Ian’s approach revolves around the equation “prognosis = diagnosis + function”, ensuring that your assessment isn’t just about pinpointing the injury but also about aligning recovery with the athlete’s current function, and personal goals.

Objective assessment

Assessing function and load tolerance

Ian likes to start by gaining an understanding of the wrist’s ability to withstand force. He does this using a range of different equipment. Using a hand grip dynamometer he assesses grip strength and symptoms with a straight elbow instead of a bent elbow, so as not to bias any other structures. He also emphasises the utility of assessing thumb pinch grip strength and endurance for those more chronic cases—for this he uses a pinch grip dynamometer, as well as weight plates; measuring the amount of time the patient can hold the weight plates can be a great measure of the thumb’s endurance and tolerance to load.

For those athletes with pain loading into extension (e.g., gymnasts or rugby players), Ian demonstrates a great quantitative assessment of extension-loading tolerance using a weight scale. See the video below taken from Ian’s Practical:

Additionally, Ian outlines his strategies for assessing wrist extensor strength, particularly Extensor Carpi Radialis Longus and Brevis, as these muscles are often working to stabilise the wrist. Key assessments Ian uses are:

• Reverse curl with a dumbbell (pain-free one repetition maximum, without compensation).
• Slow punch with a dumbbell (pain-free one repetition maximum).

Observation

Observation is a simple yet important step in the assessment process. Signs like guttering or thenar atrophy can provide valuable clues for accurate diagnosis. Simple movements, such as asking the patient to close their fist, can offer insights into the functional status of the wrist and hand. This initial observation helps identify potential issues and sets the stage for a more thorough examination.

Range Of Motion (ROM) and palpation assessment

Ian simplifies wrist ROM assessment by using a phone-based inclinometer app. He emphasises testing ROM in both open-and-closed-fist positions to differentiate between joint and soft tissue restrictions. This approach offers a comprehensive look at wrist function and highlights any areas needing further attention. See him explain this while measuring wrist flexion ROM in the below snippet from his Practical:

Importantly, while Ian demonstrates palpation of the wrist, he highlights the idea that he often avoids palpating the patient’s wrist, particularly for those more chronic, complex cases who may have seen a range of health professionals in the past.

Special tests

The ulnar side of the wrist often poses diagnostic challenges. Ian walks through how to identify issues in the Triangular Fibrocartilage Complex (TFCC), Ulnar Collateral Ligament, distal radioulnar joint, and Extensor Carpi Ulnaris (ECU). He points out that tendinopathy-like ECU pain can sometimes signal an underlying stability problem, prompting him to explore further before deciding on treatment. Subluxation of the ECU is something to be aware of; Ian compares this to peroneal tendon subluxation in the lower-limb, identifying it as a potential cause of ulnar-side wrist pain and dysfunction. Be sure to watch for this when assessing wrist injuries!

Now for the radial side of the wrist, here’s something every physio wants to hear—for a quick, reliable scaphoid fracture assessment, Ian introduces a three-test cluster, see him demonstrate in this clip from his Practical:

Wrapping up

Ian’s Practical is packed with insights, from ROM assessments to tissue tolerance testing. Whether you’re a seasoned clinician or newer to the field, this class will transform how you approach wrist injuries in athletes. Understanding the diagnosis and function is the first, critical step to setting athletes up on the path to recovery!

Don’t miss out—watch the full Practical HERE and sharpen your skills today!