Elbow, Wrist, Hand - Special Tests

Question 1

Valgus Stress Test

Answer 1

+Test = pain/tenderness, increased laxity of UCL

Indicates: Sprained Medial Ulnar Collateral L. (UCL)

Arm abducted and laterally rotated

Question 2

Varus Stress Test

Answer 2

+Test = pain/tenderness w/ palpation, increased joint laxity for LCL

Indicates = Sprained lateral collateral L. (LCL)

Arm slightly adducted and internally rotated

Question 3

Tinel Test

Answer 3

For Ulnar Nerve Entrapment

Tap between olecranon and medial epicondyle in ulnar groove

+Test = tingling sensation down forearm

Indicates: Ulnar nerce entrapment/ Cubital Tunnel Syndrome

Question 4

Medial Epicondylitis Test

Answer 4

Flex wrist with elbow in full extension

+Test = pain/tenderrness around medial epicondyle

Indicates = medial epicondylitis (Golfer’s Eblow)

Question 5

Lateral Epicondylitis Test

Answer 5

Wrist extension while arm is extended

+Test = Pain in area of lateral epicondylitis

Indicates = Lateral epicondylitis (Tennis elbow)

Question 6

Tinel’s Sign

Answer 6

Tap over Transverse carpal L. with finger or reflex hammer with patient’s wrist in extension

+Test = numbness/tingling/pain radiating to thumb and index finger (where median n. distributes)

Indicates = Carpal Tunnel Syndrome

Question 7

Phalen’s Sign

Answer 7

Place dorsal aspects of patient’s hands together and force into wrist flexion - hold 60 seconds

+Test = numbness/tignling in areas where median nerve distributes

Indicates = Carpal Tunnel Syndrome

Question 8

Finkelstein Test

Answer 8

Patient makes fist encompassing their thumb. Patient ADducts the wrist

+Test = pain in first dorsal compartment (lateral wrist)

Indicates = Dequervain’s tenosynovitis

Question 9

Olecranon Bursitis

Answer 9

Student’s elbow — due to overuse of elbow, inflammation of the subcutaneous olecranon bursa

ROm is normal and region is painless

Question 10

Little League Elbow

Answer 10

• Pain over the medial epicondyle after repetative throwing – progresses to repetative pain
• Most common elbow injury in children
• Other related issues relating to throwing:

Childhood - medial apophysitis

Adolescence - medial epicondyle avulsion fracture

young adulthood - Medial collateral ligament tear

Question 11

Coupled motions at the elbow

Answer 11

1) Ulnar adduction with supination and wrist ABduction
2) Ulnar abduction vith pronation and wrist ADduction
3) Anterior glide of radial head with supination
4) Posterior glide of radial head with pronation

Question 12

Carpal Tunnel Syndrome

Answer 12

Entrapment of median n. when area beneath flexor retinaculum becomes inflammed

Question 13

DeQuervain’s Tenosynovitis

Answer 13

Pain and inflammation of the tendons in the first dorsal compartment due to repetative overuse

Possible Inflammation sites:

1) Tendon Sheath
2) Abductor Pollicis longus
3) Abductor Pollicis Brevis