Special Tests - Wrist

Question 1

What is Phalen’s Test?

Answer 1

Tests for median nerve impingement within the carpel tunnel

Question 2

How to perform Phalen’s Test?

Answer 2

Explain that you are doing a test which will involve putting pressure on a nerve within the wrist.

Place backs of hands together with elbows up for 30 to 60 s

Question 3

what is a positive phalen’s test?

Answer 3

pain, tingling or numbness in their hands - usually over the thumb, index, middle and half of ring finger - indicates carpal tunnel syndrome - the longer it takes to bring it on, the more likely it is to be false positive

Question 4

why does Phalen’s indicate carpal tunnel?

Answer 4

When hands are held in that position…
- increased pressure in the carpal tunnel - compresses the median nerve between the PROXIMAL EDGE OF THE FLOR RETINACULUM and DISTAL END OF RADIUS

If the nerve is irritated or impinged, then the compression brings on nerve symptoms - burning, tingling, altered sensation

Question 5

what is Tinel’s test for?

Answer 5

median nerve impingement and carpal tunnel syndrome

Question 6

How to perform tinsel’s test?

Answer 6

tap directly over carpal tunnel using index and third finger (using force) 5-6 times - REPEAT ON BOTH SIDES

Question 7

What is a positive tinel’s test?

Answer 7

burning, tingling or altered sensation over the thumb, index, middle and half of the ring ringer

Question 8

Why does a Tinel’s test indicate carpal tunnel?

Answer 8

Applying direct mechanical stimulus to the carpal tunnel - increasing pressure in the carpal tunnel and compressing the median nerve further.

In carpal tunnel - the neve is already impinged and irritated - so it is hypersensitive to the mechanical stimulus - this triggers the symptoms.

Question 9

What is Finklestein’s Test?

Answer 9

A test for De Quevain’s syndrome - inflammation of the shared tendon sheath of extensor pollicis brevis and abductor pollicis longus - in the 1st compartment of the extensor retinaculum

Question 10

How to perform the Finklestien’s Test?

Answer 10

Two parts - ask if they feel pain or a difference in the two sides

1. make a fist - thumb inside fist - actively ulnar deviate
2. make a fist - thumb inside fist - passively ulnar deviate

Question 11

what is a postive finklestiens test?

Answer 11

difference between two sides, reproduction of the patients symptoms, pain over area

Question 12

why does finklestiens test cause pain?

Answer 12

placing mechanical stretch on the shared synovial sheath of AbPL and EPB in compartment 1 of the flexor retinaculum - if this is irritated, the menovure will cause pain