Orthopedic Diagnosis: Wrist and Hand

Question 1

Tinel Wrist Sign

Answer 1

• Positive: Reproduction of pain, tenderness and/or paresthesia in the median nerve distribution area (thumb, 2^nd, 3^rd and the lateral ½ of the 4^th digit)
  
  • Indicates: Median neuritis, possibly carpal tunnel syndrome

Question 2

Phalen Sign

Answer 2

• Positive: Reproduction of pain and/or paresthesia in the median nerve distribution area (1^st, 2^nd, 3^rd and the lateral ½ of the 4^th digit)
  
  • Indicates: Median neuritis, possibly carpal tunnel syndrome

Question 3

Reverse Phalen Sign

Answer 3

• Positive: Reproduction of pain and/or paresthesia in the median nerve distribution area (1^st, 2^nd, 3^rd and the lateral ½ of the 4^th digit)
  
  • Indicates: Median neuritis, possibly carpal tunnel syndrome

Question 4

Prayer Sign

Answer 4

• Positive: Reproduction of pain and/or paresthesia in the median nerve distribution area (1^st, 2^nd, 3^rd and the lateral ½ of the 4^th digit)
  
  • Indicates: Median neuritis, possibly carpal tunnel syndrome

Question 5

Finkelstein Test

Answer 5

• Positive: Pain distal to the radial styloid process
  
  • Indicates: Stenosing tenosynovitis of the abductor pollicis longus and extensor pollicis brevis tendons (DeQuervain’s Disease)

Question 6

Bunnel-Littler Test

Answer 6

1. Positive: Flexion of the proximal interphalangeal joint cannot be achieved
   
   • Indicates: Joint capsule contracture
2. Positive: Flexion of the proximal interphalangeal joint is acheived
   
   • Indicates: Tight intrinsic muscles

Question 7

Retinacular Test

Answer 7

1. Positive: Flexion of the distal interphalangeal joint cannot be achieved
   
   • Indicates: Joint capsule contracture
2. Positive: Flexion of the distal interphalangeal joint is achieved
   
   • Indicates: Tight retinacular ligament

Question 8

Allen Test

(Right side only)

Answer 8

• Positive: A delay of more than 10 seconds (Evans says 5 seconds) in returning a reddish color to the hand
  
  • Indicates: Radial or ulnar artery insufficiency. The artery being held (occluded) by the examiner is not the artery being tested

Question 9

Allen Test

(Left side only)

Answer 9

• Positive: A delay in more than 10 seconds (Evans says 5 seconds) in returning a reddish color to the hand
  
  • Indicates: Radial or ulnar artery insufficiency. The artery being held (occluded) by the examiner is not the artery being tested

Question 10

Fromet Paper Sign

Answer 10

• Positive: The patient is seen to flex the thumb thereby recruiting the median nerve to compensate for apparent weakness
  
  • Indicates: Ulnar nerve paralysis (weakness of the adductor pollicus muscle)

Question 11

Bracelet Test

Answer 11

• Positive: Acute forearm, wrist and hand pain
  
  • Indicates: Significant for rheumatoid arthritis (confirm with diagnostic imaging and. laboratory tests)