Elbow, wrist, hand Special Tests

Question 1

Varus stress test (elbow)

Answer 1

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

Question 2

Valgus stress test (elbow)

Answer 2

For MCL sprain

• Elbow 20-30 degrees flexion
• Same as varus stress test, but apply valgus force while palpating medial joint line

Question 3

Cozen’s test

Answer 3

For lateral epicondylitis

• Elbow in slight flexion.
• Pt makes a fist, pronates forearm, radially deviates, and extends wrist against resistance.
• Positive: Pain or weakness

Question 4

Lateral epicondylitis test

Answer 4

• 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

Question 5

Medial Epicondylitis test

Answer 5

• Therapist supinates pt’s forearm, extends wrist, extends elbow
• Positive test: pain

Question 6

Mill’s test

Answer 6

• Therapist pronates pt’s forearm, flexes wrist, extends elbow
• Positive pain:

Question 7

Elbow flexion test

Answer 7

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

Question 8

Pinch grip test

Answer 8

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)

Question 9

Tinel’s sign (elbow)

Answer 9

For ulnar nerve compression or compromise

• Elbow in slight flexion
• Therapist taps between olecranon and medial epicondyle
• Positive: tingling in ulnar nerve distribution

Question 10

Ulnar collateral ligament instability test (wrist)

Answer 10

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

Question 11

Allen test

Answer 11

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

Question 12

Bunnel-Littler test

Answer 12

• 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

Question 13

Tight retinacular ligament test

Answer 13

• 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

Question 14

Carpal compression test (median nerve compression test)

Answer 14

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

Question 15

Froment’s sign

Answer 15

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

Question 16

Phalen’s test

Answer 16

For carpal tunnel syndrome

- Pt flexes wrists maximally, hold for 60 seconds (upside down prayer)

Question 17

Tinel’s sign (wrist)

Answer 17

For median nerve compression at carpal tunnel

- Tap volar aspect of pt’s wrist

Question 18

Finkelstein’s test

Answer 18

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

Question 19

Grind test (wrist)

Answer 19

For DJD in CMC joint

- Apply compression and rotation through thumb metacarpal

Question 20

Murphy sign

Answer 20

For dislocated lunate

• Pt makes a fist
• Positive: patient’s third metacarpal remains level with second and fourth metacarpals.