Test #3 Special Tests Flashcards
Bunnell-Littler Test (aka Intrinsic Plus Test)
To determine if flexion restriction at the PIP joint is due to
Tightness of intrinsic muscles, or
Restriction at MCP capsule
MCP joint is held by the clinician in a few degrees of extension
Clinician’s other hand attempts to flex the PIP joint
If the joint cannot flex, tightness of the intrinsics or a joint capsular contraction should be suspected
From this position, the clinician slightly flexes the MCP joint (relaxing the intrinsics) & attempts to flex the PIP joint
If the joint can now flex, the intrinsics are tight
If the joint still cannot flex, the restriction is probably due to a capsular contraction of the joint
Haines–Zancolli Test
Used to determine whether restricted flexion at the DIP joint is due to
A restriction of the PIP joint capsule, or
Tightness of the oblique retinacular ligament
Test is the same as the Bunnell–Littler test, except at the PIP and DIP joints
Clinician positions and holds the PIP joint in a neutral position with one hand
Attempts to flex the DIP joint with the other hand
If no flexion is possible, it can be due to either a tight retinacular ligament or capsular contraction
PIP joint is then slightly flexed (relaxes the retinacular ligament)
If the can now flex, the restriction is due to tightness in the retinacular ligament
If the DIP cannot flex, then the restriction is due to a capsular contraction
Thumb CMC Grind Test
Used to assess the 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 is reproduction of the patient’s symptoms and crepitus
Lichtman Test
Provocative test for midcarpal instability
Patient’s forearm in positioned in pronation and the hand is held relaxed and supported
Clinician gently moves the patient’s hand from RD to UD while compressing the carpus into the radius
Positive test is when the midcarpal row appears to jump or snap from an palmarly subluxed position to the height of the proximal row
Linscheid Test
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
Carpal Shake Test
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 is pain or resistance to this test
Press (Sit to Stand) Test
Used to assist in diagnosis of TFCC tear
Patient sitting with both hands on the armrests of a chair
Patient attempts to lift their body slightly off the chair
Positive test is pain or resistance to this test
Supination Lift Test
Patient in sitting with the elbows flexed to 90 degrees and the forearms supinated
Patient is asked to place the palms flat on the underside of a table or against the clinician’s hands
Patient is asked to lift the table or push up against the resisting clinician hands
Positive test for a TFCC tear is pain localized to the ulnar side of the wrist with difficulty applying force
Ulnar Impaction Test
Used to assess the articulation between the ulnar carpus and the TFCC
Patient is sitting with the elbow flexed to 90o, 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 is pain
Finkelstein Test
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 is pain over the 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 indicate Wartenberg syndrome, Basilar Thumb Arthrosis, EPB entrapment or Intersection Syndrome
Radioulnar Ballottement Test
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 is pain or mobility and is suggestive of radioulnar instability
Wartenberg Test
Used with patients who complain of pain over the distal radial forearm associated with paresthesias 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 is indicated by local tenderness and paresthesia with this maneuver
Finger Extension Test
Used to demonstrate Posterior Wrist Syndrome (localized scapholunate synovitis)
Clinician instructs the patient to fully flex 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 is reproduction of central posterior wrist pain
Pain can also indicate the possibility of Kienbock disease, carpal instability, joint degeneration, or synovitis
Scapholunate Shear Test
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 is reproduction of the patient’s pain and laxity
FDS Test
Used to test the integrity of the FDS tendon
Clinician holds the patient’s fingers in extension, except for the finger being tested
Patient is instructed to flex the finger at the PIP joint
If this is possible, the 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
FDP Test
These tendons work only in unison
To test the FDP, 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, the FDP is intact
If no flexion is possible, the tendon is severed or the muscle denervated
Integrity of the Central Slip (Ext. Hood Rupture)
Patient flexes the finger to 90o 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 force at the PIP joint, and fixed extension at the distal joint, indicates a complete rupture of the central slip
Piano Key Test
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 the index finger of the other hand
Ulnar head is depressed in an anterior direction (as in depressing a key on a piano)
Positive test is pain and/or excessive movement in an anterior direction or if (upon release) the bone springs back into its high posterior position
Can indicate TFCC tear or triquetral instability
Lunotriquetral Shear (Reagan) Test
Used to assess 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 thumb and second finger of the other hand
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 is crepitus, clicks or pain in this area
Watson Test for Carpal Instability
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 is pain at the posterior wrist or a clunk (suggests instability)
Gamekeeper’s or Skier’s Thumb Test
Patient in sitting
Clinician stabilizes the patient’s hand with one hand and takes the patient’s thumb into extension with the 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
Murphy Sign
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
Allen Test
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 be seen to regain their normal color
This procedure is repeated with the radial artery released and 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
Tinel (Percussion) Test for CTS
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
APB Weakness for CTS
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 is weakness in some abduction with resisted testing as compared to the other hand
Phalen Test for CTS (Wrist Flexion)
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
Reverse Phalen Test for CTS (Prayer)
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
Wrist Flexion and Median Nerve Compression Test
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
Median Nerve Compression Test/Pressure Provocation Test
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
Constant, gentle pressure is applied with the 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
Froment Sign
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)
