Special Tests: Wrist & Hand Flashcards
Scaphoid instability test= Watson test
Find the anterior scaphoid, apply pressure to the scaphoid as going passively from ulnar deviation to radial deviation
Clunk
-as the scaphoid “clunks” over the radial head
Scaphoid Instability
Ulna Snuffbox Test
pressure on triquetrum in sulcus distal to ulnar head formed by ECU & FCU tendons
reproduces pt’s pain
LT instability
Piano Key sign
Distal ulna is grasped & moved passively in volar & dorsal direction at extremes of pronation & supination
Pain, tenderness, & increased mobility relative to uninjured side
DRUJ instability
TFCC Load test
Ulnarly deviating & axially loading wrist and moving it volarly & dorsally or by rotating the forearm
Ulnarly deviating & axially loading wrist and moving it volarly & dorsally or by rotating the forearm
TFCC Integrity
Grind Test
Axial compression of the 1st metacarpal with rotation
pain & crepitus
MC Arthrits
Finkelstein Test
Flexion of thumb with ulnar deviation (grab thumb with other fingers)
Pain on radial aspect of wrist
DeQuervian’s Synovitis
Bunnel-Littler Test
hold pt’s MCP joint in max extension & then passively flex IP joint. The MCP joint is then held in flexion & examiner passively flexes the PIP joint again.
- If PIP can be passively flexed more when MCP joint is held in flexion then intrinsic tightness
- If PIP can be passively flexed more when MCP joint is held in extension (than when in flexion) then extrinsic tightness
- If no difference in PIP joint motion when MCP is flexed or extended, then PIP joint capsular & collateral ligament tightness
Allen Test
Place fingers over ulnar & radial arteries at wrist. Pt forcibly opens & closes hand to exsanguinate it while examiner continues occluding ulnar & radial arteries. Next pt opens hand & examiner releases one artery & observes flushing of hand (revascularization). Steps are then repeated while other artery is tested
Abnormal when reflow to all or part of hand takes > 7 sec
Blood flow to the hand
Ulnar snuff box test
Apply pressure on triquetrum in sulcus distal to ulnar head formed by ECU & FCU tendons
Reproduces pain
LT insability
Grip strength
Sit with shoulder adducted, elbow flexed to 90 degrees, & forearm neutral. Wrist should be between 0-30 degrees extension.
Compare 3 test average to other side
Pinch Strength
Assess 3 pinch types:
Prehension (key or lateral)
Three-jaw chuck (3-point chuck)
Tip pinch
Compare 3 test average to other side
Froment’s sign
Jeanne’s sign
Figure of 8
Start at distal ulnar styloid & go across volar surface to radial styloid, cross the wrist diagonally to 5th metacarpal joint line, then across the volar surface of the MCP joints from the 5th to the 2nd MCP joint line, & finally cross the wrist dorsally & diagonally to the ulnar styloid
2-point discrimination
Static 2 point discrimination begins with discriminator 5 mm apart. Pt responds to whether 1 or 2 points is perceived.
Less than 7/10 correct responses
Semmes Weinstein
1.65-4.08 filaments applied 3x in same place, all others just once
of thinnest filament that can be felt 1/3 times
2.83 filament is normal perception
Moberg
Use 3 fingers to pick up objects and put them in a bucket (score 1), or pick up and recognize (score 2)
The time to either put all 12 items in a bucket or recognize all 12 objects
innervation density & interpretation of sensation in median nerve distribution
