Wrist And Hand

Question 1

Special tests

Answer 1

1) Phalen’s manoeuvre
2) Tinel’s sign
3) Finkelstein’s test

Question 2

1)Phalen’s manoeuvre

Answer 2

symptoms of carpal tunnel syndrome are caused by compression of the median nerve

patient sitting

ask patient to hold their wrists in complete flexion pushing the dorsal aspects of their hands together for 30-60 seconds

does this position cause any tingling or numbness or burning

The test increses pressure within carpal tunnel and can compress median nerve between prox edege of retinaculum and ant boarder of distal radius

Question 3

2) Tinel’s sign

Answer 3

sitting arms supinted on a table

support forearm your hand underneath dorsum of their hand and perform repetive tapping using finger tips of index and middle fingers over carpal tunnel region at the wrist

intensity should be enough to provoke a response but not too hard.

does tapping cause burning tingeling or numbness

caused be abnormal mechano sensativity of nerve due to compressive effects

Question 4

3) Finkelstein’s test

Answer 4

sitting elbow flexed to 90 degrees and forearm in id-prone position

Passive
support wrist and habd then passively take wrist into ulnar deviation and thumb into opposition

Active
also can be done by asking patient to active oppose thumb and make a fist around it with the 2-5 digits and then ulna deviate

any pain in wrist/thumb

increases the mechanical stretch of the tendon sheath of extensor pollicis brevis (EPB) and abductor pollicis longus (APL) which are situated in the first compartment of the extensor retinaculum at the level of the wrist.

A positive Finkelstein’s test indicates the presence of De Quervains’ Syndrome which is the localised inflammation of this tendon sheath.