Palpable Bony Landmarks of the Wrist

The palpable bony landmarks on the palmar aspect of the wrist (Fig. 1) are the pisiform, the scaphoid tuberosity, the trapezial tuberosity, the volar radial styloid and the hook of the hamate. The pisiform (1) is easily palpated at the ulnar end of the distal wrist crease (2). We then move radially from the pisiform along the distal wrist crease. The junction of the thenar crease with the distal wrist crease is the next landmark. The scaphoid tuberosity (3) and the trapezial tuberosity (4) lie immediately radial to this junction with the scaphoid tuberosity lying proximal to the junction and the trapezial tuberosity lying distal to it. The scaphoid tuberosity becomes more prominent with radial deviation and less prominent with ulnar deviation. This will allow you to differentiate it from the closely located trapezial tuberosity that does not change with radial or ulnar deviation of the wrist. The scaphoid tuberosity is located more proximal than you imagine.

Continuing further radially along the distal wrist crease brings us to the junction with the dorsal pigmented skin. The body of the trapezium can be palpated below this junction. If we move proximal to this, we enter a hollow bounded radially by the tendon of the abductor pollicis longus (APL) (5). The bony prominence proximal to this hollow is the volar radial styloid (6). A line drawn from the pisiform to second metacarpophalangeal joint allows identification of the hook of the hamate (7). It is the first bony prominence along this line approximately 2 cm distal and radial to the pisiform.

The palpable bony landmarks on the dorsal aspect of the wrist (Fig. 2) are the Lister tubercle, the proximal pole of the scaphoid, the dorsal pole of the lunate, the dorsal radial styloid, the scaphoid waist, the ulnar head and the dorsal triquetrum. The Lister tubercle (8) is a bony prominence on the dorsum of distal radius. Immediately distal to the Lister tubercle is the hollow of the radio-carpal joint. The proximal pole of the scaphoid (9), the scapholunate ligament and the dorsal pole of the lunate (10) can be palpated in this hollow with wrist flexion. The majority of the scaphoid and the lunate descend into the scaphoid and the lunate fossa of the radius respectively with the wrist in neutral position and they are better palpated with the wrist in flexion.

The dorsal radial styloid (11) is palpable at the base of the anatomical snuff box (12). The scaphoid waist is palpable in the hollow of the snuff box with the wrist in ulnar deviation and slight flexion. The ulnar head (13) is the bony prominence on the dorsal ulnar aspect of the wrist. The dorsal triquetrum (14) is palpable immediately distal to the ulnar head and is also more apparent in wrist flexion (Supplemental information: Video).

Declarations

Conflict of Interest:

The author does NOT have any potential conflicts of interest with respect to this manuscript.

Funding:

The author received NO financial support for the preparation, research, authorship and/or publication of this manuscript.

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Not required.

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There is NO information (names, initials, hospital identification numbers or photographs) in the submitted manuscript that can be used to identify patients.

Acknowledgements:

I would like to thank Tanay Jacob for his help with the images and the video.

Supplementary File:

The supplementary files for this manuscript (listed as follows) are online only and can be accessed at http://www.worldscientific.com/doi/suppl/10.1142/S2424835524710024

Video: Palpable Bony Landmarks of the Wrist