Elbow/Wrist Tests Flashcards
Elbow fracture screen
Patient supine:
Elbow Extension Test … patient asked to fully extend elbow
Elbow Flexion Test … patient supine and asked to fully flex elbow
Elbow Pronation Test … patient asked to fully pronate forearm
Elbow Supination Test … patient asked to fully supinate forearm
Scaphoid fracture screen
•Scaphoid Fracture Test – Examiner pinches “anatomical snuff box” •Other Scaphoid Fracture Tests: Active wrist extension Active forearm pronation Thumb and index pinch (“OK sign”)
Watson scaphoid test
Positioning: forearm and hand in neutral position with very slight pronation grasp scaphoid between thumb and index
Instruction: let me know if you feel anything
Technique: passively circumduct wrist starting in slight extension and ulnar deviation, ending in radial deviation with slight flexion
Interpretation: positive is a clunk when scaphoid is releases due to the unstable scaphoid subluxating with movement and clunking back in place when pressure is released
Bracelet test
Positioning: pt seated, make a bracelet around the wrist with thumb and whatever finger can complete the circle
Instruction: let me know if you feel anything
Technique: apply lateral compressive force around the distal radius and ulna (location of a bracelet) - equal pressure on all the carpal bones.
Interpretation: positive is pain, possibly due to fracture
Cozen’s test
Positioning: palpate to find lateral epicondyle, leave thumb there. other hand will resist patient’s hand. patient arm is bent, pronated, and wrist is extended (in a fist).
Instruction: don’t let me push your hand down.
Technique: apply pressure on the hand toward wrist flexion.
Interpretation: positive is pain indicating lateral epicondylosis (inflamx/tear/fibrosis of extensor carpi radialis brevis)
Mill’s test
Positioning: palpate to find lateral epicondyle, leave thumb there. other hand to patient’s wrist. patient w/ elbow extended and forearm pronated and wrist fully flexed.
Instruction: let me know if you feel anything.
Technique: apply pressure for more wrist flexion and pronation.
Interpretation: stretching of the common extensor tendon and radial nerve. pain indicative of lateral epicondylosis
Reverse Cozen’s test
Positioning: patient with elbow flexed, forearm supinated and wrist fully flexed (fingers open). palpate medial epicondyle and leave thumb there. other hand to palmar side of patient’s hand.
Instruction: don’t let me lift your hand
Technique: apply upward pressure to move wrist toward extension.
Interpretation: positive is pain which may indicate medial epicondylosis
(Inflamx/strain/fibrosis of the pronator teres and flexor carpi radialis longus tendon).
Reverse Mill’s test
Positioning: patient with elbow fully extended, forearm supinated, and wrist fully extended. palpate medial epicondyle and leave thumb there. other hand to patient’s hand.
Instruction: let me know if you feel anything.
Technique: press on patient’s hand to hyperextend the wrist.
Interpretation: stretches the common flexor tendon. positive is pain which may indicate medial epicondylosis
(Inflamx/strain/fibrosis of the pronator teres and flexor carpi radialis longus tendon).
Valgus stress test
Positioning: 2 tests -
- elbow is fully extended
- elbow flexed 30 degs, forearm supinated
Instruction: keep your arm relaxed
Technique: press medially from lateral epicondyle
Interpretation: quick pulls on the ligaments. do not want an ‘empty feel’
Varus stress test
Positioning: 2 tests -
- elbow is fully extended
- elbow flexed 30 degs, forearm supinated
Instruction: keep your arm relaxed
Technique: press laterally from medial epicondyle
Interpretation: quick pulls on the ligaments. do not want an ‘empty feel’
Tinel’s sign (ulnar nerve and median nerve)
Positioning: patient elbow slightly flexed
Instruction: let me know if things feel uncomfortable
Technique:
Ulnar - tap the ulnar nerve with one finger pad (between medial epicondyle and ulna)
Median - tap the median nerve as it enters the carpal tunnel
Interpretation: assessing nerve status
Froment’s sign
Positioning: doesn’t matter
Instruction: pinch thumb and index finger like a “duck beak” not an “OK sign”
Technique: observe
Interpretation: correct action is done by ulnar nerve. if it’s damaged and the median nerve takes over, OK sign will be observed instead.
Active ulnar tension test
aka Elbow Flexion Test
Positioning: flex elbow past 90; pronate forearm; extend wrist; abduct shoulder
Instruction: hold this position and let me know if it becomes uncomfortable
Technique: have patient hold position for a minute
Interpretation: stresses the ulnar nerve, will have parasthesia or discomfort w/in a minute
Phalen’s test
Positioning:
v1 - patient presses the backs of the hands together (maximal flexion) in front of the trunk
v2 - patient seated, hold the patient’s wrist in deep flexion
Instruction: let me know what you feel
Technique: hold wrist in flexion (version 2). both versions held 60 sec
Interpretation: discomfort around wrist could mean carpal tunnel
Median nerve compression test
Positioning: patient seated, forearm and wrist neutral
Instruction: let me know how what you feel
Technique: double thumb compression just proximal to transverse carpal ligament for 15 sec – 2 mins
Interpretation: positive test … median nerve symptoms in hand
