Elbow, Hand & Wrist Flashcards
Procedure for Cozens test?
- 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.
Interpretations of Cozens test?
- Pain in the lateral epicondyles = (+) test for lateral epicondylitis/tennis elbow.
Procedure for Mills test?
- 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.
Interpretations of Mills test?
- Pain in the lateral epicondyle = (+) test for lateral epicondylitis.
Procedure for Kaplan’s sign?
- 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.
Interpretations of Kaplan’s sign?
- 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.
Procedure for Pinch Grip test?
- Dr. asks patient to pinch their index finger and thumb together tip to tip.
Interpretations of Pinch Grip test?
- If patient can only touch pad to pad not tip to tip = (+) test for anterior interossei branch of the median nerve.
Procedure of Medial Epicondylitis test?
- Patient standing
- Dr. grasps the patients hand, supinate and extend their wrist.
- Dr. asks patient to resist force applied.
Interpretations of Medial Epicondylitis test?
- Pain in the medial aspect of the elbow = (+) for medial epicondylitis.
Procedure for Tinel’s sign?
- Dr. uses a reflex hammer or finger tip and taps the ulnar nerve in the cubital tunnel.
Interpretations of Tinel’s sign?
- Pain, referred pain or tingling with tapping = (+) test for ulnar nerve neuritis or neuroma.
Tinel’s Sign Wrist
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
Tinels Sign Wrist: Positive
Pain or tingling in the distribution of the median nerve distal to the wrist indicated: median nerve
compression in the carpal tunnel
Phalen’s
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
Phalen’s: Positive
Pain or tingling in the hand along the distribution of the median nerve indicates: carpal tunnel compression of the median nerve
Reverse Phalen’s
● 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
Reverse Phalen’s: Positive
Pain or tingling in the hand along the distribution of the median nerve indicates carpal tunnel compression of the median nerve
Tinel’s Sign Elbow
● 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
Tinel’s Sign Elbow: Positive
Pain, referred pain, or tingling indicates damage to the ulnar nerve
Froment’s Sign
● 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
Froment’s Sign: Positive
Failure to maintain grip or weakness when paper is pulled away, indicating ulnar nerve palsy
Stress Test Wrist
● 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
Stress Test Wrist: Positives
Pain or increased movement indicates damage to the supporting ligaments or problems with
the tunnels
Finkelstein’s
● 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
Finkelstein’s: Positives
Sharp pain in tunnel 1 indicates DeQervain’s or stenosing tenosynovitis
Carpal Lift Test
● 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
Carpal Lift Test: Positives
Pain in the wrist indicating carpal fracture or sprain of the wrist
Finsterer’s Sign
● 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
Finsterer’s Sign: Positives
Pain in the center of the wrist indicates Kienbock’s disease (lunate avascular necrosis)
