The hand and wrist are assessed around the function you need to regain.

Irritation and narrowing of the sheath around the abductor pollicis longus and extensor pollicis brevis tendons on the thumb side of the wrist.

• Pain and tenderness on the radial side of the wrist
• Pain with gripping, twisting, lifting a child or moving the thumb
• Local swelling or crepitus over the tendons
• Pain provoked when the thumb is held in the fist and the wrist moves towards the ulna

Narrowing of the passage through which a flexor tendon runs, usually at the A1 pulley, preventing smooth tendon gliding.

• Clicking or catching while bending and straightening the finger
• The finger may lock in flexion and release suddenly
• Pain or a nodule at the palmar base of the finger
• Stiffness that is often worse in the morning

Irritation where the first dorsal-compartment tendons cross the second-compartment tendons in the distal dorsoradial forearm. It should be distinguished from de Quervain tenosynovitis.

• Pain several centimetres above the dorsoradial wrist
• Crepitus or rubbing with wrist movement
• Pain with repeated extension, rowing, skiing or weight training
• Swelling and tenderness over the tendon intersection

Overload of the ECU tendon or instability within its sheath on the ulnar side of the wrist, often after forceful rotation or in racket sports.

• Ulnar and dorsal wrist pain
• Pain with resisted extension and ulnar deviation
• Snapping of the tendon during pronation and supination
• Pain with racket grip, lifting or weight-bearing through the hand

Compression of the median nerve as it passes through the carpal tunnel. Prolonged compression can cause sensory loss and weakness of the thenar muscles.

• Numbness, tingling, burning or pain in the thumb, index, middle and radial half of the ring finger
• Night symptoms or symptoms while holding a phone or driving
• Dropping objects and difficulty with fine movements
• Weakness or wasting at the thumb base in advanced cases

Compression of the ulnar nerve on the palmar-ulnar side of the wrist. Sensory and motor findings depend on the compression level and must be distinguished from cubital tunnel syndrome.

• Numbness or tingling in the little finger and ulnar half of the ring finger
• Weak grip and pinch
• Difficulty spreading and closing the fingers
• Pain or pressure at the ulnar palm, sometimes after cycling or prolonged weight-bearing

Irritation or compression of the superficial sensory branch of the radial nerve near the thumb side of the wrist. It does not cause motor weakness.

• Burning, tingling or numbness over the dorsal thumb and hand
• Pain from a watch, bracelet, handcuff or local pressure
• Tenderness along the nerve course
• No associated weakness of the hand muscles

Traumatic or degenerative injury to structures that stabilise and cushion the ulnar wrist and distal radioulnar joint.

• Ulnar-sided wrist pain
• Clicking or catching during forearm rotation
• Pain with gripping, twisting or weight-bearing through the hand
• Instability or weakness while lifting objects

A sprain or tear of the ligament between the scaphoid and lunate. It may occur acutely after a fall or gradually lead to instability and arthritis.

• Dorsal or radial wrist pain after a fall
• Pain with weight-bearing, pushing or forceful grip
• Clicking, catching or a sense of instability
• Swelling and reduced grip strength

A sprain or tear of the stabilising ligament at the thumb base, usually after forced deviation away from the palm. A displaced tear may form a Stener lesion.

• Pain and swelling on the ulnar side of the thumb MCP joint
• Weak pinch or difficulty holding objects
• Thumb instability
• Bruising and pain after a fall or sports injury

Stretching or tearing of one or more wrist ligaments after a fall, hyperextension or twisting. An apparent “sprain” may conceal a fracture or instability.

• Pain and swelling after trauma
• Pain with movement, gripping or weight-bearing
• Bruising and restricted movement
• Clicking, deformity or pain that fails to improve requires reassessment

Degeneration of the trapeziometacarpal joint at the thumb base, particularly affecting pinch and grip function.

• Thumb-base pain when opening jars, turning keys or pinching
• Reduced grip and pinch strength
• Swelling, deformity or prominence at the thumb base
• Stiffness and reduced thumb opening

Degenerative change in cartilage and bone, often post-traumatic at the wrist or affecting the DIP, PIP and MCP joints of the hand.

• Pain and stiffness aggravated by use
• Joint swelling or bony enlargement
• Reduced movement, grip and dexterity
• Crepitus, deformity or locking in some cases

Inflammation of one or more joints caused by rheumatological disease, crystals or infection. Septic arthritis requires urgent treatment.

• Joint pain, warmth, swelling and restricted movement
• Prolonged morning stiffness and symmetrical involvement in some inflammatory diseases
• Sudden severe onset with gout or infection
• Redness, fever or a nearby wound requires prompt assessment

Avascular necrosis of the lunate caused by impaired blood supply, which may progress to bone collapse and wrist arthritis.

• Deep central-dorsal wrist pain
• Swelling and stiffness
• Pain with loading or wrist extension
• Progressive reduction in grip strength

A benign fluid-filled lump arising from a joint or tendon sheath, most commonly on the dorsal or palmar wrist.

• A lump that may change in size
• Pain or discomfort with movement and weight-bearing
• Restricted movement when the cyst is large
• Numbness or weakness if it compresses a nerve

Progressive thickening of the palmar fascia that forms nodules and cords and draws one or more fingers into flexion. It is not a tendon disorder.

• Firm nodules or cords in the palm
• Progressive inability to place the hand flat
• Contracture most often affecting the ring and little fingers
• Difficulty placing the hand in a pocket, wearing gloves or gripping large objects

A condition involving disproportionate pain and sensory, autonomic and motor changes after a fracture, operation or other injury. Diagnosis is clinical and other causes must be excluded.

• Burning pain or marked sensitivity to light touch
• Swelling and changes in skin temperature or colour
• Sweating or changes in nails and hair
• Stiffness, weakness and limited use of the hand

A fracture of the radius near the wrist, usually after a fall onto an outstretched hand. It may be extra-articular or intra-articular and may accompany other injuries.

• Immediate pain, swelling and bruising
• Wrist deformity when displaced
• Difficulty or inability to use the hand
• Finger numbness, a cold hand or an open wound requires emergency assessment

A fracture of the scaphoid, usually after a fall onto an outstretched hand. Initial X-rays may be normal and limited blood supply increases the risk of nonunion.

• Pain on the thumb side of the wrist
• Tenderness in the anatomical snuffbox
• Pain with gripping or axial thumb compression
• Mild swelling and persistent pain after an apparently minor injury

Fracture of another carpal bone or a complex displacement around the lunate after high-energy trauma. Median nerve injury may occur and urgent assessment is required.

• Marked wrist pain and swelling after trauma
• Severely restricted movement and grip
• Deformity or deep central wrist pain
• Median-distribution numbness or sudden hand weakness

Fractures of the palm or finger bones after impact, crushing, a fall or twisting. Finger rotation and joint involvement influence clinical decisions.

• Local pain, swelling and bruising
• Deformity, shortening or finger overlap when making a fist
• Pain with gripping or finger movement
• An open wound, sensory loss or poor circulation requires emergency care

Joint displacement or injury to the volar stabiliser, most commonly at the PIP joint after hyperextension. An avulsion fracture may coexist.

• Visible deformity or pain after the finger bends backward
• Swelling and bruising around the joint
• Restricted flexion or extension
• Instability, locking or numbness after trauma

Mallet finger involves the terminal extensor tendon; jersey finger is an avulsion of the flexor digitorum profundus from the distal phalanx. Early recognition is important.

• Inability to actively straighten the fingertip with mallet finger
• Inability to actively bend the distal joint with jersey finger
• Pain, swelling or bruising after impact or forced pull
• Fingertip deformity and loss of function

Infection of the skin, deep tissues, joint or tendon sheath after a wound, bite or blood-borne spread. Infectious flexor tenosynovitis is a hand emergency.

• Increasing redness, warmth, swelling and pain
• A finger held flexed with severe pain on passive extension
• Tenderness along the flexor tendon sheath
• Fever, wound discharge, red streaking or feeling systemically unwell