Component of evaluation	Evaluation area	Diagnoses to consider
Inspection	Bilateral symmetry of knuckles in clenched fist	Asymmetry suggests metacarpal fracture
	Dorsal or volar wrist mass	Ganglion cyst
	Skin ecchymoses or swelling	Localized injury
	Symmetric bulk of thenar and hypothenar eminences	Thenar atrophy suggests chronic median nerve injury; hypothenar atrophy suggests chronic ulnar nerve injury
Palpation	Anatomical snuff-box tenderness	Scaphoid bone fracture
	Carpal tunnel (Tinel sign)	Median nerve injury
	Guyon canal (depression between hamate hook and pisiform), asymmetric or excessive tenderness	Ulnar nerve injury
Range of motion	Symmetric flexion and extension of all digits	Inability to flex or extend individual digit suggests tendon injury or fracture
Muscle strength	Active wrist extension	Radial nerve injury
	Active wrist flexion	Ulnar and/or median nerve injury
	Digit adduction or abduction	Ulnar nerve injury
	Pincer mechanism thumb and index digit	Ulnar nerve injury
Sensory/neurologic	Phalen maneuver at wrist	Median nerve injury
	Sensation lateral hand	Ulnar nerve injury
	Sensation of web space between thumb and index digit	Radial nerve injury