Elbow and Wrist Tests Flashcards
what is the valgus stress test?
- Cup posterior aspect of the patient’s elbow in one hand
- Hold wrist in other hand
- Use hand on elbow as a fulcrum around which other hand will force
the forearm laterally (valgus stress) - Assess at 0 degrees, 30 degrees, 90 degrees
Positive => pain, increased medial joint gapping
what is the findings for valgus stress test
Sprain of medial collateral ligament
what is the varus stress test
- Cup posterior aspect of the patient’s elbow in one hand
- Hold wrist in other hand
- Use hand on elbow as a fulcrum around which other hand will force
the forearm medially (varus stress) - Assess at 0 degrees, 30 degrees, 90 degrees
Positive => pain or laxity in the lateral joint of the elbow
what are the findings for the varus stress test
lateral collateral ligament pathology
what is the mills test
- Place patient in position where their elbow is extended, wrist
pronated, and flexed - Examiner pushes on wrist while supporting elbow into flexion
Positive => pain at lateral epicondyle
what is the finding for Mill’s test?
lateral epicondyle ( tennis elbow)
what is the reverse mill’s test
Reverse Mill’s Test
1. Place patient in position where their elbow is extended, wrist
pronated, and extended
2. Examiner pushes on wrist while supporting the elbow in extension
Positive => pain at medial epicondyle
what is the finding for the reverse mill’s test
medial epicondylitis (golfer’s elbow)
what is the ulnar nerve instability test
- Examiner places patients arm in abduction and external rotation
- While palpating the ulnar nerve at the ulnar groove, flex and extend
the patient’s arm repeatedly
Positive => examiner can palpate the nerve as it subluxes (partial
dislocation) out of the ulnar groove
what is the finding for ulnar nerve instability
ulnar nerve instability
what is the tinel sign
- Designed to elicit tenderness over a neuroma within the nerve
- Tap nerve between the olecranon and the medial epicondyle
Positive => tingling sensation down the forearm in the ulnar nerve
distribution
what are the findings for the tinel sign
A neuroma in the ulnar nerve
what is the cozen’s test
- Stabilize patient’s forearm
- Have patient make a fist and pronate, radially deviate, and extend the
wrist - Examiner forces wrist into flexion against patient’s resistance
Positive => sudden severe pain at thhme lateral epicondyle (common
extensor origin)
what is the findings for cozen’s test
lateral epicondylitis (tennis elbow)
what is the reverse cozen’s test
- Stabilize patient’s forearm
- Have patient make a fist, supinate, and flex the wrist
- Examiner forces wrist into extension against patient’s resistance
Positive => sudden severe pain at the medial epicondyle (common flexor origin)
what is the findings for reverse cozen’s test
medial epicondylitis (golfer’s elbow)
what is the supination lift test
- Patient seated with elbow flexed to 90
- Forearms supinated, place the hands on the underside of a table
- Ask patient to try to lift the table
Positive => pain on the ulnar side of the wrist and difficulty applying force
what is the finding for the supination lift test
Dorsal tear of the triangular fibrocartilage complex (TFCC)
what is the triangular fibrocartilage complex (TFCC) load test?
- Examiner holds the patient’s forearm with one hand and the patient’s hand with the other hand
- Examiner then ulnar deviates the wrist and applies a stretch like pressure in the same direction, while moving hand dorsally and towards the palm
Positive => pain, clicking, or crepitus in the area of TFCC
what is the finding for triangular fibrocartilage complex (TFCC) load test
TFCC tear/injury
what is the Allen’s test
- Patient opens and closes their hand multiple times, then makes a fist
- Examiner holds down the radial and ulnar arteries with the thumb and index finger
- Let go of the artery being tested and the patient’s hand should go pink on the side of the artery just released
- Repeat same evaluation for the other artery
Positive => skin stays white, no apparent return of blood flow after decompression of the artery
what is the finding for Allen’s test
Vascular compromise to radial or ulnar artery
what is the Finkelstein’s test
- Patient makes a fist with thumb tucked in
- Examiner deviates wrist in the ulnar deviation
Positive => skin stays white, no apparent return of blood flow after decompression of the artery
what is the finding for Finkelstein’s test
First dorsal compartment stenosing
tenosynovitis (abductor pollicis
longus and extensor pollicis brevis) = DeQuervain’s tenosynovitis
what is the Phalen’s test
- Patient places the dorsal aspect of one hand against the dorsal aspect of the other, causing flexion of the wrists
- Position held for at least one minute while the patient reports changes in sensation or pain
Positive => reproduction of neurologic symptoms
what is the findings for Phalen’s test
Carpal tunnel syndrome (CTS)
what is the Tinel’s sign
- Patient sitting with both wrists facing up on their lap
- Examiner uses a reflex hammer on their re-enforced finger to tap the transverse carpal ligament on the volar aspect of the wrist
Positive => carpal tunnel syndrome (CTS)
what is the findings for Tinel’s sign
Paresthesia in the median nerve distribution with percussion
what is the pronator teres test
- Patient stands with elbow in 90 of flexion
- Examiner places one hand on the client’s elbow for stabilization and
the other hand grasps the patient’s hand in a handshake position - Patient holds this position as the practitioner attempts to supinate the
patient’s forearm (forcing patient to contract the pronator muscles) - While holding resistance against pronation, the clinician extends the
patient’s elbow - *Patient should keep the elbow relaxed during the test – holding
elbow firmly in flexion will not allow for elbow extension
Positive => if the patient’s pain or discomfort is reproduced
what is the findings for pronator teres test
Median nerve compression by pronator teres
what are the special test for lateral epicondylitis?
- Cozens
- mills
- varus stress test
- tinels
what are the special test for medial epicondylitis
- reverse cozens
- reverse mills
- valgus stress test
- tinel’s
what are the special test for carpal tunnel syndrome
- phalen’s
- reverse Phalen’s
- tinel’s
- pronator teres test
- allen’s test
