Elbow, wrist, hand Special Tests Flashcards
Varus stress test (elbow)
For LCL sprain
- Elbow 20-30 degrees flexion
- Therapist: One hand on elbow, other proximal to pt’s wrist
- Apply varus force while palpating lateral joint line
- Positive: Increased laxity, apprehension, pain
Valgus stress test (elbow)
For MCL sprain
- Elbow 20-30 degrees flexion
- Same as varus stress test, but apply valgus force while palpating medial joint line
Cozen’s test
For lateral epicondylitis
- Elbow in slight flexion.
- Pt makes a fist, pronates forearm, radially deviates, and extends wrist against resistance.
- Positive: Pain or weakness
Lateral epicondylitis test
- Therapist stabilizes elbow with one hand, places other hand on dorsal aspect of patient’s hand, distal to PIP joint.
- Pt extends third digit against resistance
- Positive: Pain or weakness
Medial Epicondylitis test
- Therapist supinates pt’s forearm, extends wrist, extends elbow
- Positive test: pain
Mill’s test
- Therapist pronates pt’s forearm, flexes wrist, extends elbow
- Positive pain:
Elbow flexion test
For cubital tunnel syndrome
- Patient fully flexes elbows while extending their wrists, holding position for 3-5 minutes
- Positive: Tingling or paresthesia in ulnar nerve distribution
Pinch grip test
For pathology of anterior interosseous nerve
- Pt pinches tips of index finger and thumb together
- Positive: pt can’t pinch tip-to-tip (instead presses pads of fingers together)
Tinel’s sign (elbow)
For ulnar nerve compression or compromise
- Elbow in slight flexion
- Therapist taps between olecranon and medial epicondyle
- Positive: tingling in ulnar nerve distribution
Ulnar collateral ligament instability test (wrist)
For gamekeeper’s/ skier’s thumb (ulnar collateral ligament damage)
- Therapist holds pt’s thumb in extension, applies valgus force to the MCP of the thumb
- Positive: Excessive valgus movement
Allen test
For occlusion of radial or ulnar artery
- Pt opens and closes hand sever times
- Pt maintains hand in closed position
- Therapist compressed radial and ulnar arteries
- Patient relaxes hand
- Therapist releases pressure on one of the arteries
- Positive: Delayed or absent flushing of radial or ulnar half of hand
Bunnel-Littler test
- MCP in slight extension
- Therapist attempts to move PIP into flexion
- If PIP doesn’t flex, indicates tight intrinsic muscles or capsular tightness
- If PIP fully flexes with MCP in slight flexion, there may be intrinsic muscle tightness without capsular tightness
Tight retinacular ligament test
- PIP held neutral
- Therapist flexes DIP
- If therapist unable to flex DIP, retinacular ligaments or capsule may be tight
- If therapist can flex DIP with PIP in flexion, retinacular ligaments may be tight, capsule may be normal
Carpal compression test (median nerve compression test)
For carpal tunnel syndrome
- Therapist holds pt’s wrist with both hands, applies pressure over median nerve in carpal tunnel for 30 seconds
- May place wrists in 60 degrees flexion first
Froment’s sign
For ulnar nerve compromise or paralysis
- Pt asked to hold piece of paper between thumb and index finger
- Therapist attempts to pull away paper from pt
- Positive: pt flexing DIP of thumb (adductor pollicis paralysis)
- Jeanne’s sign: At the same time, pt also hyperextends MCP of thumb
Phalen’s test
For carpal tunnel syndrome
- Pt flexes wrists maximally, hold for 60 seconds (upside down prayer)
Tinel’s sign (wrist)
For median nerve compression at carpal tunnel
- Tap volar aspect of pt’s wrist
Finkelstein’s test
For tenosynovitis of thumb (de Quervain’s disease)
- Pt makes a fist with thumb tucked inside
- Therapist ulnarly deviates the wrist
- Positive: Pain over APL and EPB tendons
Grind test (wrist)
For DJD in CMC joint
- Apply compression and rotation through thumb metacarpal
Murphy sign
For dislocated lunate
- Pt makes a fist
- Positive: patient’s third metacarpal remains level with second and fourth metacarpals.
