Special Tests of the FWH Flashcards
1
Q
Bunnel-Littler Test (Intrinsic Plus Test)
A
- Used to determine if flexion restriction at the PIP joints is due to tightness of the intrinsic muscles, or restriction at the MCP capsule
- MCP Joint held by the clinician in a few degrees of extension, Clinicians other hand attempts to flex PIP
- If the joint cannot flex, tightness of the intrinsics or a joint capsular contraction should be suspected
- From this position, clinician slightly flexes the MCP joint (relaxing intrinsics) and attempts to flex the PIP
- If the joint can now flex=intrinsics are tight
- If it can’t= restriction prob due to capsular contraction
2
Q
Haines-Zancolli Test
A
- Used to determine whether restricted flexion at the DIP joint is due to a restriction of the PIP J capsule or tightness of the oblique retinacular ligament
- Same as above, except with PIP and DIP
- Clinician positions and holds PIP joint in neutral with one hand, attempts to flex the DIP with the other
- If no flexion, it can be due to a tight retinacular ligament or capsular contraction
- PIP joint is then slightly flexed(relaxes retinacular lig)
- If can now flex= retinacular ligament tightness
- If DIP can’t= capsular contraction
3
Q
Thumb CMC Grind Test
A
- Used to assess integrity of the thumb CMC joint
- Clinician grasps the thumb metacarpal using the thumb and index finger of one hand
- With the other hand, grasp the proximal aspect of the thumb CMC joint
- Provide an axial compressive force, combined with rotation, to the thumb CMC joint
- Positive test= reproduction of the patient’s symptoms and crepitus
4
Q
Lichtman Test
A
- Provacative test for midcarpal instability
- Patient’s forearm is positioned in pronation and the hand is held relaxed and supported
- Clinician gently moves the patients hand from RD to UD while compressing the carpus into the radius
- Positive test= he midcarpal row appears to jump or snap from a palmarly subluxed positive to the height of the proximal row
5
Q
Linscheid Test
A
- Used to detect ligamentous injury and instability of the second and third CMC joints
- Clinician supports the metacarpal shafts
- Press distally over the metacarpal heads in palmar and dorsal directions
- Positive test produces pain localized to the CMC joints
6
Q
Carpal Shake Test
A
- Used to assist in diagnosis of intercarpal synovitis
- Clinician grasps the patient’s distal forearm and the patient is asked to relax
- Clinician shakes the wrist
- Positive test= pain or resistance to this test
7
Q
Press (sit to stand) Test
A
- Used to assist in diagnosis of TFCC tear
- Patient sitting with both hands on the armrests of a chair
- Patient then attempts to lift their body slightly off the chair
- Positive test= pain or resistance to this test
8
Q
Supination Lift Test
A
- Patient in sitting with elbows flexed to 90 and the forearms supinated
- Patient is asked to place the palms flat on the underside of a table or against the clinicians hands
- Patient is asked to lift the table or push up against the the resting clinicians hands
- Positive test= pain localized to the ulnar side of the wrist with difficulty appling force (TFCC tear)
9
Q
Ulnar Impaction Test
A
- Used to assess the articulating between the ulnar carpus and the TFCC
- Patient is sitting with the elbow flexed to 90, wrist positioned in UD, and fingers positioned in a slight fist
- Clinician loads the wrist via a compressive force through the 4th and 5th metacarpals
- Positive test= pain
10
Q
Finkelstein Test
A
- Used to detect tenosynovitis of the APL and EPB
- Clinician stabilizes the forearm with one hand
- Grasps the thumb and deviates the wrist to the ulnar side with the other hand
- Positive test= pain over APL and EPB tendons at the wrist
- No diagnostic accuracy studies have been performed to determine the sensitivity and specificity of this test, so the results of this test must be interpreted with caution
- Positive test may also indicated Wartenberg syndrome, Basilar Thumb Arthrosis, EPB entrapment, or Intersection Syndrome
11
Q
Radioulnar Ballotment Test
A
- Used to assess DRUJ instability
- Patient’s elbow is flexed
- Clinician uses their thumb and index finger to stabilize the radius radially and the ulnar head ulnarly
- Stress is applied in an anterior-posterior direction
- Normally there is little movement in the anterior or posterior direction in maximum supination or pronation
- Positive test= pain or mobility
- Suggests radioulnar instability
12
Q
Wartenberg Test
A
- Used with patients who complain of pain over the distal radial forearm associated with paresthesisass over the posterior radial hand (Wartenberg Syndrome)
- Wartenberg test involves tapping the index finger over the superficial radial nerve on the posterior and radial side of the wrist
- Positive test= indicated by local tenderness and paresthesia with this maneuver
13
Q
Finger Extension Test
A
- Used to demonstrate posterior wrist syndrome (localized scapholunate synovitis)
- Clinician instructs the patient to fully blex the wrist and then actively extend the digits at both the IP and MCP joints
- Clinician then applies pressure on the fingers into flexion at the MCP joints while the patient continues to actively extend
- Positive test= reproduction of central post wrist pain
- Can also indicate Kienbock disease, carpal instability, joint degeneration, or synovitis
14
Q
Scapulolunate Shear Test
A
- Patient in sitting with the forearm pronated
- Clinician grasps the scaphoid with one hand
- Clinician grasps the lunate between the thumb and the index finger
- Lunate and scaphoid are then sheared in an anterior then posterior direction
- Positive test=reproduce the patient’s pain and laxity
15
Q
FDS Test
A
- Used to test integrity of the Flexor Digitorum Superficialis tendon
- Clinician holds the patients fingers in extension, except for the finger being tested
- Patient instructed to flex the finger at the PIP joint
- If this is possible= FDS tendon is intact
- Since this tendon can act independently due to the position of the finger, it is the only functioning tendon at the PIP joint
16
Q
FDP Test
A
- These tendons work only in unison
- To test the Flexor Digitorum Profundus, the PIP joint and the MCP joints are stabilized in extension
- Patient is asked to flex this finger at the DIP joint
- If flexion occurs= FDP is intact
- If no flexion= tendon is severed or muscle denervated
17
Q
Integrity of the Central Slip
A
- Patient flexes the finger to 90 at the PIP joint over the edge of the table
- Patient is then asked to extend the PIP joint while the clinician palpates the middle phalanx
- The absence of extension at the distal joint, indicates a complete rupture of the central slip
18
Q
Piano Key Test
A
- Used to evaluate the stability of the ulnomeniscotriquetral joint
- Clinician firmly stabilizes the distal radius with one hand, grasps the head of the ulna between the thumb and index finger on the other hand
- Ulnar hear is depressed in an anterior direction (like a piano key)
- Positive test= pain and/or excessive movement, or if upon release the bone springs back to high posterior
- Can indicate TFCC tear or triquetral instability
19
Q
Lunotriquetral Shear Test
A
- Assesses the integrity of the lunotriquetral ligament
- Clinician grasps the triquetrum between the thumb and the second finger of one hand
- Clinician grasps the lunate with the other
- The lunate is moved posteriorly with the thumb of one hand, while the triquetrum is pushed anteriorly in the A/P plane by the index finger of the other hand
- Positive test= crepitus, clicks, or pain
20
Q
Watson Test for Carpal Instability
A
- Used to examine the dynamic stability of the wrist, in particular the scapholunate ligament
- Patient in sitting with the elbow in approximately 90o of flexion, forearm slightly pronated, and wrist UD
- Clinician grasps the wrist from the radial side and stabilizes the scaphoid tubercle with the thumb and the posterior aspect of the scaphoid with the index finger
- Clinician uses the other hand to grasp the metacarpals
- Starting in UD and slight extension, the wrist is moved into radial deviation and slight flexion
- As the wrist is brought passively into radial deviation, the normal flexion of the proximal row forces the scaphoid tubercle into an anterior direction (into the Clinician’s thumb)
- Clinician attempts to prevent the anterior motion of the scaphoid
- When the scaphoid is unstable, its proximal pole is forced to sublux posteriorly
- Positive test=pain at the posterior wrist or a clunk
- Suggests instability
21
Q
Gamekeeper’s or Skier’s Thumb Test
A
- Patient in sitting
- Clinician stabilizes the patient’s hand with one hand and takes the patient’s thumb into extension with other
- While maintaining the thumb into extension, the clinician applies a valgus stress to the MCP joint of the thumb to stress the UCL
- Positive test is present if the valgus movement is greater than 30–35 degrees, indicating a complete tear of the UCL and the accessory collateral ligaments
22
Q
Murphy Sign
A
- Patient is asked to make a fist
- If the head of the third metacarpal is level with the second and fourth metacarpals, the sign is positive for the presence of a lunate dislocation
23
Q
Allen Test
A
- Used to determine the patency of the vessels supplying the hand
- Clinician compresses both the radial and ulnar arteries at the wrist, and then asks the patient to open and clench the fist 3-4 times to drain the venous blood from the hand
- Patient is then asked to hold the hand open while the clinician releases the pressure on the ulnar artery while maintaining pressure on the radial artery
- Fingers and palm should regain their normal color
- This procedure is repeated with the radial artery released w/compression on the ulnar artery maintained
- Normal filling time is usually less than 5 seconds
- A distinct difference in the filling time suggests the dominance of one artery filling the hand
24
Q
Tinel (Percussion) Test
A
- Used to assist in the diagnosis of CTS
- The area over the median nerve is tapped gently at the anterior surface of the wrist
- If this produces tingling in the median nerve distribution, then the test is positive
25
Q
APB Weakness for CTS
A
- Patient is sitting with their hand resting on the table
- Clinician asks the patient to touch the pads of the thumb and small finger together
- Clinician applies a strong force in order to resist thumb abduction
- Positive test=weakness in some abduction with resisted testing as compared to the other hand
26
Q
Phalen Test for CTS
A
- Patient sitting with wrists flexed and elbows flexed
- Positive test is if the patient experiences numbness or tingling throughout the median nerve distribution of the hand within 30-45 seconds
27
Q
Reverse Phalen Test for CTS
A
- Patient sitting with wrists extended and elbows flexed
- Positive test is if the patient experiences numbness or tingling throughout the median nerve distribution of the hand within 30-45 seconds
28
Q
Wrist Flexion and Median Nerve Compression Test
A
- Patient sitting with the elbow fully extended, forearm supinated, and the wrist flexed to 60o
- Clinician applies a constant pressure over the median nerve at the carpal tunnel using the thumb
- Positive test for CTS is the reproduction of symptoms along the median nerve distribution within 30 seconds
29
Q
Median Nerve Compression Test/Pressure Provocation Test
A
- Patient sitting
- Clinician grasps patient’s hand with thumbs directly over the median nerve as it passes under the flexor retinaculum between the FCR and the palmaris longus
- Gentle pressure applied w/ thumbs for 15-120 seconds
- Positive test is the reproduction of pain, paresthesia, or numbness distal to the site of compression in the distribution of the median nerve
30
Q
Froment Sign
A
- Used to define weakness in the Adductor Pollicis due to ulnar nerve palsy
- Patient pinches the index finger and thumb together without flexion occurring at the DIP joint (tongue depressor or paper is useful)
- Clinician tried to pull the object from the patient
- Positive test is inability to complete or hold this maneuver (patient will use Flexor Pollicis Longus to compensate)