Special Orthopedic Tests : Forearm, Wrist & Hand

Question 1

Ligamentous Instability Test for the Fingers

Answer 1

Process :
Examiner
1. Stabilizes finger with one hand proximal to joint to be tested
2. Grasps the fingers distal to the joint to be tested, with other hand
3. Distal hand is used to apply varus or valgus stress to PIP or DIP
+ve Sign : Excessive movement, pain
+ve Indicates : Collateral ligament laxity

Question 2

Murphy’s Sign

Answer 2

Process :
1. Client makes a fist
2. Examiner observes
+ve Sign : 3rd metacarpal level with 2nd & 4th metacarpals
+ve Indicates : Lunate dislocation

Question 3

Thumb Ulnar Collateral Ligament Laxity or Instability Test

Answer 3

Process :
1. Patient is seated
2. Examiner stabilizes patient’s hand with one hand
3. Extends patient’s thumb & applies valgus stress to thumb MCP
+ve Sign :
- Valgus movement is greater than 30-35 degrees
- Laxity less than 30-35 degrees
+ve Indicates :
1. Complete tear of ulnar collateral ligament and accessory collateral ligaments
2. Partial torn ligaments

Question 4

Finkelstein Test

Answer 4

Process :
1. Client makes a fist with thumb inside fingers
2. Examiner deviates wrist toward ulnar side
+ve Sign : Pain over abductor pollicis longus & extensor pollicis brevis tendons
+ve Indicates : de Quervain’s tenosynovitis or Hoffman disease (thumb paratenonitis)

Question 5

Allen Test

Answer 5

Process :
1. Patient opens & closes hand several times as quickly as possible & then squeezes hand tightly
2. Examiner applies pressure to ulnar & radial arteries at wrist
3. Client opens hand while pressure maintained over arteries
4. One artery is released
5. Examiner looks to see if the hand flushes
6. Other artery tested in same fashion

Question 6

Digit Blood Flow

Answer 6

Process :
1. Examiner compresses nail bed, and then releases pressure
2. Notes time taken for color to return to nail
+ve Sign : Colour takes longer than 3 seconds to return
+ve Indicates : Arterial insufficiency