Musculoskeletal: Upper Extremity Special Tests: Wrist and Hand Flashcards
Phalanx: Bunnell Littler Test
Why: Differentiate between sources of PIP flexion restriction as MCP capsule OR intrinsic tightness.
How: Patient sits with arm on table. Therapist supports arm distal to the elbow. The Therapist passively extends to MCP and then passively flexes the PIP joint. The Therapist then passively flexes the MCP and then passively flexes the PIP.
Positive Test: If the patients flexion at the PIP is restricted the same with both MCP extension and flexion then capsular tightness sis suspected. If PIP flexion increases with MCP flexion then intrinsic tightness is suspected.
Phalanx: Haines Zancolli Test
Why: Differentiate between sources of DIP flexion restriction as PIP capsular tightness OR tightness to the oblique retinacular ligament.
How: Patient sits next to mat table with hand resting on mat table. Therapist supports the arm proximal to the elbow. The therapist then passively extends the PIP and flexes the DIP. The therapist then passively flexes the PIP and flexes the DIP.
Positive Test: If there is no change in the amount of restricted DIP flexion with the PIP both extended and flexed then this indicates capsular tightness, if the amount of DIP flexion does not increase with PIP flexion then this indicated a tight oblique reticular ligament.
Forearm: Radioulnar Ballotment test
Why: To assess for distal radioulnar joint instability.
How: Patient rests arm on table. Therapist grasps and stabilizes the radius and hand with one hand and then grabs the ulna with the other. The therapist passively moves the ulna in a dorsal/palmar direction opposite the radius. Test in both fully pronated and supinated.
Positive Test: Instability or pain at the distal forearm.
Thumb: CMC Grind Test
Why: To assess the integrity of the first CMC joint.
How: Patient sits with forearm and hand resting on table. Therapist stabilizes the wrist and carpals proximal to the first CMC. The therapist then applies a load to the thumb into the CMC joint and “grinds” the CMC joint.’
Positive Test: Pain in the first CMC joint, may be indicative of arthritis or synovitis.
Carpals: Scapholunate Shear Test
Why: Assess the integrity of the scapholunate ligament.
How: Patient is seated with arm resting on mat table. Therapist grabs on either side of the wrist with thumbs and index fingers on either side of both the scaphoid and lunate. The therapist passively shears the scaphoid and lunate in opposite directions.
Positive Test: Instability or pain at the scapholunate joint.
Carpals: Watson’s Test
Why: To assess for dynamic stability of the scapholunate ligament.
How: Patient rests arm on table and flexes elbow to 90 degrees. Therapist stabilizes the scaphoid and passively moves the wrist and hand into extension and ulnar deviation. The therapist then maintains stability on the scaphoid and passively moves the wrist into flexion and radial deviation while attaining stability on the scaphoid.
Positive Test: Clunking, clicking, or pain felt as the wrist moves from Ext+UD to Flex+RD due to dorsal displacement of the scaphoid due to the instability to the scapholunate ligament.
Forearm: Piano Key Test
Why: To assess for stability of the distal radioulnar joint
How: Patient sits with arm resting on mat table. Therapist stabilizes the radius and applies a downward force to the ulna.
Positive Test: Excessive palmar movement of the ulna, pain, or the ulna springs back the neutral position.
Carpals: Reagan’s Test
Why: To assess for stability of the lunotriquetral interosseous ligament.
How: Patient sits next to table with hand resting on mat table. Therapist grabs both sides of the wrist and stabilizes the triquetrum. The therapist then moves the lunate in the dorsal and palmar direction.
Positive Test: Crepitus, clicks, clunks, instability, oor pain in the wrist.
Triangular Fibrocartilage Load Test: TFCC Load Test
Why: To assess stability of the TFCC.
How: Patient sits next to mat table with elbow on table flexed to 90 degrees. Therapist stabilizes the radius and ulna and passively moves the hand into ulnar deviation to end range. Once at end range ulnar deviation apply a force into the TFCC.
Positive Test: Pain, crepitus, clicks in the TFCC.
Radial and Ulnar Arteries: Allen’s Test
Why: To assess patency of the radial and ulnar arteries.
How: Patient sits with hand resting on mat table. Patient repeatedly makes a fist 5-10 times and then closes the hand completely and tightly. The therapist then compresses the radial and ulnar artery. Patient is then asked to open the hand after a few seconds of compression. The therapist then releases either of the arteries while compressing the other.
Positive Test: The patients hand should be occluded prior to releasing pressure and then fill with blood after one of the arteries is released. Can be used for both arteries.
Carpal Tunnel: Phalen’s test
Why: Assess for symptoms of carpal tunnel syndrome
How: Patient stands and places the dorsal aspect of their hands together with elbows straight. They then flex the elbows to 90. (Reverse prayer position). Patient holds the position for several seconds.
Positive Test: Pain, numbness or tingling after 45 seconds of holding the position.
Carpal Tunnel Syndrome: Reverse Phalen’s
Why: Assess for symptoms of carpal tunnel syndrome
How: Patient stands and places the palmar aspect of their hands together with elbows straight. They then flex the elbows to 90. (Prayer position). Patient holds the position for several seconds.
Positive Test: Pain, numbness or tingling after 1 minute seconds of holding the position.
Carpal Tunnel with Median Nerve Focus:
Tinel’s Sign
Why: To asses for irritability of the median nerve at the carpal tunnel.
How: Patient sits with arm resting on mat table supinated. The therapist taps at the carpal tunnel over the area of the median nerve.
Positive Test: Pain, numbness or tingling in the median nerve distribution.
Carpal Tunnel with Ulnar Nerve Focus:
Tinel’s Sign
Why: To asses for irritability of the ulnar nerve at the carpal tunnel.
How: Patient sits with arm resting on mat table supinated. The therapist taps at the Guyan tunnel over the area of the ulnar nerve.
Positive Test: Pain, numbness or tingling in the ulnar nerve distribution.
Thumb: Finkelstein’s Test
Why: To assess for DeQuervain’s Syndrome/to assess for stenosing tenosynovitis of abductor pollicis longus and extensor pollicis brevis.
How: Patient sits with arm on mat table. Patients ulnar aspect of forearm is on table with ulnar aspect of hand off the edge. The patient then wrap their fingers around the thumb and ulnar deviates the wrist putting the tendon sheaths of the abductor pollicis longus and extensor pollicis brevis on stretch.
Positive Test: Pain in the proximal thumb.
