Wrist and Hand Special Tests Flashcards
Ligamentous Instability Test for the Fingers
Purpose: to test the integrity of the collateral ligaments of the fingers
-therapist stabilizes the finger with one hand proximal to the joint being tested and other hand grasps finger distal to the joint being tested
-therapist’s distal hand applies a varus or valgus stress to the joint (PIP or DIP) to test the integrity of the collateral ligaments
Positive: amount of laxity found is compared with unaffected side which is tested first
Thumb Ulnar Collateral Ligament Laxity or Instability Test
Purpose: to test for a complete tear of the ulnar collateral and accessory collateral ligaments
Position: patient seated, therapist stabilizes patient’s hand with one hand, stabilizing the 1st metacarpal and
takes thumb into extension with other hand
-while holding patient’s thumb in extension, therapist applies a valgus stress (n: put away from the mid line) to MCP joint of the thumb stressing the ulnar collateral ligament
Positive test: valgus movement is greater than 30 - 35 degrees (indicates tear of ulnar collateral ligament and accessory collateral ligaments)
-tests for ‘game keeper’s or skier’s thumb’
Lunotriquetral Ballottement Test (Shuck, Reagan’s Test)
Purpose: to test the integrity of the lunotriquetral ligament (Physiotutors)
-therapist grasps the patient’s triquetrum between thumb and second finger of one hand and the lunate with the thumb and second finger of the other hand
-therapist then mobilizes the lunate up and down (anterior and posterior)
Positive: laxity, crepitus or pain (is indicative of lunotriquetral instability)
Murphy’s Sign
Purpose: to test for a lunate dislocation
-ask patient to make a fist and assess the metacarpal heads
Postive: if third metacarpal head is level with the second and fourt ( n: push back) is indicative of the lunate dislocation) (n: look at posterior)
Scaphoid Stress Test
Purpose: scaphoid instability as it gets forced out of the scaphoid fossa of the radius (Physiotutors)
Position: patient seated, therapist holds patient’s wrist so that thumb applies pressure over distal scaphoid
-have patient radially deviate wrist (n: can be positive too, because sometimes the clt doesn’t know exactly the movement), normally patient should be unable to deviate wrist
Positive: if excessive laxity, causes ‘clunk ‘and pain
Piano Keys Test
Purpose: test for instability of the distal radioulnar joint
Position: patient seated with both forearms pronated, therapist stabilizes patient’s arm with one hand so that therapist’s index finger can push down on distal ulna while other hand supports the patient’s hand
-therapist pushes down on distal ulna as one would push down on a piano key
Positive: results in a difference in mobility and pain / tenderness compared to the unaffected side
Axial Load Test
(n: try to compress to joint)
Purpose: test for fracture of the metacarpal or adjacent carpal bones or joint arthrosis
Position: patient seated while therapist stabilizes patient’s wrist with one hand
-therapist applies axial compression to the thumb or fingers
Positive: pain and/or crepitus
Finkelstein Test (n: thumb inside the fist)
Purpose: test for the presence of deQuervain’s Tenosynovitis or Hoffman’s Disease
-have patient make a fist with thumb inside their fingers and then therapist stabilizes forearm and passively ulnarly deviates the wrist
Positive: pain in abductor pollicis longus and extensor pollicis brevis tendon is indicative of a
paratendinitis in these two tendons)
Note:
Since the test can cause some discomfort normally, it is important to compare with unaffected side to see if symptoms are actually reproduced.
Sweater Finger Sign
Purpose: test for ruptured flexor digitorum profundus tendon
-ask patient to make a fist
Positive: distal phalanx of one of the fingers does not flex (most often the ring finger) (n: hook in the sweater)
Tinel’s Sign (at the wrist)
Purpose: test for Carpal Tunnel Syndrome
-therapist taps over the carpal tunnel (median nerve) at the wrist
Positive: paresthesia or tingling in the Median nerve distribution (to the thumb, index, middle and
lateral half of ring finger)
Phalen’s Test (Wrist Flexion Test)
- Purpose: test for Carpal Tunnel Syndrome
- therapist flexes patient’s wrists maximally and holds this position for one minute by pushing the wrists
together (n: can be done actively, 30s)
Positive: paresthesia or tingling in the Median nerve distribution
Reverse Phalen’s Test (Prayer Test)
Purpose: test for pathology of the Median nerve
-therapist extends patient’s wrist while asking the patient to grip the therapist’s hand
-therapist then applies direct pressure over the carpal tunnel for one minute
(n: can be done actively)
Positive: produces similar symptoms as in Phalen’s test
Carpal Compression Test
Purpose: test for Carpal Tunnel Syndrome
Position: patient seated with forearm supinated, therapist holds wrist in both hands and applies direct, even pressure over the median nerve in the carpal tunnel for up to 30 seconds
Positive: production of symptoms indicative of Carpal Tunnel Syndrome
Allen Test
Purpose: tests the efficiency of arteries and determines which artery provides the major blood supply
to the hand (n: see if they do the job)
-have patient open and close their hand several times quickly
-patient then squeezes their hand and holds while therapist compresses radial and ulnar arteries and then patient opens their hand (pressure is maintained)
-one artery is tested by releasing the pressure over that vessel to see if the hand flushes, the other artery is tested in the same way
- Positive: the blood doesn’t refill properly, white )
Digital Blood Flow (n: nail bed)
Purpose: tests for arterial insufficiency
-therapist compresses the patient’s nail bed and notes the time it takes for the colour to return (3 seconds is normal)
-if return takes longer, there is considered to be arterial insufficiency, need to compare to the unaffected side in order to have some indication of restricted flow
