Elbow, Hand & Wrist

Question 1

Procedure for Cozens test?

Answer 1

• Patient standing arms by their sides, elbows flexed to 90.
• Dr. stands on testing side and asks patient to make a fist, pronate and extend their wrist
• Dr. stabilizes the patients forearm.
• Dr. tells patient to resist against flexion pressure.
• This stresses the extensory carpi radialis longus and brevis.

Question 2

Interpretations of Cozens test?

Answer 2

• Pain in the lateral epicondyles = (+) test for lateral epicondylitis/tennis elbow.

Question 3

Procedure for Mills test?

Answer 3

• Patients arm is at their side with elbow flexed to 90.
• Dr. asks the patient to pronate their arm and flex the wrist.
• Dr. stabilizes the patients forearm.
• Dr. asks the patient to supinate against resistance.

Question 4

Interpretations of Mills test?

Answer 4

• Pain in the lateral epicondyle = (+) test for lateral epicondylitis.

Question 5

Procedure for Kaplan’s sign?

Answer 5

• 1st: Patient is standing with arm flexed at 90, holding a dynamometer in their hand, with their wrist slightly extended.
• Dr. asks patient to squeeze dynamometer as hard as they can.
• 2nd: After that take not of results and grasp patients forearm distal to the lateral epicondyles.

Question 6

Interpretations of Kaplan’s sign?

Answer 6

• 1st: Weakness and or pain in the lateral epicondyle = (+) test for lateral epicondylitis.
• 2nd: after grasping patients forearm, an increase in strength or decrease in pain = (+) lateral epicondylitis.

Question 7

Procedure for Pinch Grip test?

Answer 7

• Dr. asks patient to pinch their index finger and thumb together tip to tip.

Question 8

Interpretations of Pinch Grip test?

Answer 8

• If patient can only touch pad to pad not tip to tip = (+) test for anterior interossei branch of the median nerve.

Question 9

Procedure of Medial Epicondylitis test?

Answer 9

• Patient standing
• Dr. grasps the patients hand, supinate and extend their wrist.
• Dr. asks patient to resist force applied.

Question 10

Interpretations of Medial Epicondylitis test?

Answer 10

• Pain in the medial aspect of the elbow = (+) for medial epicondylitis.

Question 11

Procedure for Tinel’s sign?

Answer 11

• Dr. uses a reflex hammer or finger tip and taps the ulnar nerve in the cubital tunnel.

Question 12

Interpretations of Tinel’s sign?

Answer 12

• Pain, referred pain or tingling with tapping = (+) test for ulnar nerve neuritis or neuroma.

Question 13

Tinel’s Sign Wrist

Answer 13

Hand is supinated and wrist is stabilized. Tap along the median nerve in the carpal tunnel.
-Intern performs the test bilaterally
-Intern asks patient if there is pain
-Intern verbalizes findings

Question 14

Tinels Sign Wrist: Positive

Answer 14

Pain or tingling in the distribution of the median nerve distal to the wrist indicated: median nerve
compression in the carpal tunnel

Question 15

Phalen’s

Answer 15

Patient is seated
● Intern has the patient flex their wrist and put the backs of their hands together and lower
their elbows
● Patient is instructed to hold this position for 60 seconds (less if symptoms appear)
● Intern performs the test bilaterally
● Intern asks the patient if there is pain - where, what, rate, radiate

Question 16

Phalen’s: Positive

Answer 16

Pain or tingling in the hand along the distribution of the median nerve indicates: carpal tunnel compression of the median nerve

Question 17

Reverse Phalen’s

Answer 17

● Patient is seated
● Intern has the patient extend their wrist and put their hands together and raise their
elbows
● Patient is instructed to hold this position for 60 seconds (less if symptoms appear)
● Intern performs the test bilaterally
● Intern asks the patient if there is pain - where, what, rate, radiate

Question 18

Reverse Phalen’s: Positive

Answer 18

Pain or tingling in the hand along the distribution of the median nerve indicates carpal tunnel compression of the median nerve

Question 19

Tinel’s Sign Elbow

Answer 19

● Patient is seated
● Intern taps the ulnar nerve in the cubital tunnel using a reflex hammer or their fingertips
● Intern performs the test bilaterally
● Intern asks the patient if there is pain - where, what, rate, radiate

Question 20

Tinel’s Sign Elbow: Positive

Answer 20

Pain, referred pain, or tingling indicates damage to the ulnar nerve

Question 21

Froment’s Sign

Answer 21

● Patient is seated
● Patient grasps a piece of paper between any two fingers
● Intern performs the test bilaterally
● Intern asks the patient if there is pain - where, what, rate, radiate

Question 22

Froment’s Sign: Positive

Answer 22

Failure to maintain grip or weakness when paper is pulled away, indicating ulnar nerve palsy

Question 23

Stress Test Wrist

Answer 23

● Patient is seated
● Intern grasps the patient’s hand and stresses the patient’s hand in the following directions
○ Ulnar stress test (ulnar deviation)
○ Radial stress test (radial deviation)
○ Flexion stress test (passive wrist flexion)
○ Extension stress test (passive wrist extension)
● Intern performs the exam bilaterally
● Intern asks the patient if there is pain - where, what, rate, radiate

Question 24

Stress Test Wrist: Positives

Answer 24

Pain or increased movement indicates damage to the supporting ligaments or problems with
the tunnels

Question 25

Finkelstein’s

Answer 25

● Patient is seated
● Intern has the patient make a fist by crossing their thumbs over their palm, and flexing
their fingers over their thumb. They then instruct the patient to ulnar deviate their wrist
● Intern performs the test bilaterally
● Intern asks the patient if there is pain - where, what, rate, radiate

Question 26

Finkelstein’s: Positives

Answer 26

Sharp pain in tunnel 1 indicates DeQervain’s or stenosing tenosynovitis

Question 27

Carpal Lift Test

Answer 27

● Patient is seated
● Patient’s hand is palm down on the exam table
● Intern holds a finger down and asks the patient to extend that finger
● Intern performs the test bilaterally
● Intern asks the patient if there is pain - where, what, rate, radiate

Question 28

Carpal Lift Test: Positives

Answer 28

Pain in the wrist indicating carpal fracture or sprain of the wrist

Question 29

Finsterer’s Sign

Answer 29

● Patient is seated
● Intern taps over the 3rd metacarpal on the back of the patient’s hand
● Intern performs the test bilaterally
● Intern asks the patient if there is pain - where, what, rate, radiate

Question 30

Finsterer’s Sign: Positives

Answer 30

Pain in the center of the wrist indicates Kienbock’s disease (lunate avascular necrosis)