Wrist Flashcards
Sitting
Quickly open and close hand several times and then squeeze the hand tightly. With thumb and index finger, compress radial and ulnar arteries. Open hand while maintaining pressure over the arteries. Test artery by releasing the pressure over it to see if the hand flushes.
Allen Test
Patency of the radial and ulnar arteries
Abnormal filling of blood within the hand
Sitting
Metacarpophalangeal joint is slightly extended while moving PIP joint into flexion. MCP joint is flexed and PIP joint is flexed.
Bunnel-Littler Test
Tightness in structures surrounding the MCP joints.
Flexion is limited in both cases if capsule is tight.
More PIP flexion with MCP flexion, then the intrinsic muscles are tight.
Sitting
Stabilize hand and take thumb into extension. Then apply a valgus stress to the metacarpophalangeal joint, stressing the ulnar collateral ligament and accessory collateral ligament.
Thumb Ulnar Collateral Ligament Laxity or Instability Test
Complete tear of the ulnar collateral and accessory collateral ligaments
Valgus movement is greater than 30° - 35°
Sitting
Flex carpometacarpal joint to 30° and apply a valgus stress.
Gamekeeper’s or Skier’s Thumb Test
Tear of the ulnar collateral ligament
Valgus movement is greater than 30° - 35°
Sitting
Hold PIP joint in a neutral position while flexing the DIP joint. Then flex PIP joint and flex DIP joint
DIP joint doesn’t flex, then retinacular ligaments are tight.
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Tight Retinacular Test
Tightness around PIP joint
PIP joint is flexed and the DIP joint flexes, then retinacular ligaments are tight and capsule is normal
Sitting
Put both arms in pronation. Stabilize arm and push down on the distal ulna
Piano Keys Test
Instability of the distal radioulnar joint
Any differences in mobility, production of pain and/or tenderness compared with the nonsymptomatic arm
Sitting
Tap over the carpal tunnel on wrist
Tinel’s Sign at the Wrist
Carpal Tunnel Syndrome
Tingling/paresthesia in the median nerve distribution and the thumb, index finger and middle and lateral half of the ring finger
Sitting
Flex wrist maximally and hold position for 1 minute by pushing the wrists together
Phalen’s Test
Carpal Tunnel Syndrome
Tingling/paresthesia in the median nerve distribution and the thumb, index finger and middle and lateral half of the ring finger
Sitting
Extend wrist while patient grips the PT’s hand. Apply direct pressure over the carpal tunnel for 1 minute Or, put hands together and bring the hands down toward the patient’s waist, keeping the palms in full contact
Reverse Phalen’s Test
Pathology of median nerve
Tingling/paresthesia in the median nerve distribution and the thumb, index finger and middle and lateral half of the ring finger
Sitting
Patient grabs a piece of paper with the thumb and index finger and the PT pulls the paper away
Froment’s Sign
Ulnar nerve paralysis
Terminal phalanx of thumb flexes as the PT tries to pull away the paper
Sitting
Use a two-point discriminator to apply pressure on two adjacent points on the finger. Attempt to find the minimal distance where the patient can distinguish between the two points
Two Point Discrimination Test
Level of sensory innervation within the hand
Normal amount discriminated is less than 6mm
Sitting
Patient makes a fist
Murphy’s Sign
Lunate dislocation
Head of the third metacarpal is level with the second and fourth metacarpals
Sitting
Patient makes a fist with the thumb inside the fingers. Stabilize the forearm and deviate the wrist toward the ulnar side
Finkelstein Test
Presence of de Quervain’s tenosynovitis
Pain over the abductor pollicis longus and extensor pollicis brevis tendons
