Wrist-Hand Special Tests Flashcards
Finkelstein’s Test
PURPOSE- Determine the presence of de Quervain disease, a paratenonitis in the
thumb
DESCRIPTION- The patient makes a fist with the thumb inside the fingers. The examiner stabilizes the forearm and deviates the wrist toward the ulnar side.
RESULT- Pain over the abductor pollicis longus and extensor pollicis brevis tendons at the wrist and is indicative of a paratenonitis of these two tendons.
Bunnel-Littler Special test
PURPOSE- Identifies tightness in structures surrounding the MCP joint
DESCRIPTION- The metacarpophalangeal joint is held slightly extended while the examiner moves the proximal interphalangeal joint into flexion, if possible.
RESULT- If the test is positive (which is indicated by inability to flex the proximal interphalangeal joint), there is a tight intrinsic muscle or contracture of the joint capsule. If the metacarpophalangeal joints are slightly flexed, the proximal interphalangeal joint flexes fully if the intrinsic muscles are tight, but it does not flex fully if the capsule is tight. The patient remains passive during the test. This test is also called the intrinsic-plus test
Ligament Instability Test
PURPOSE- Identify ligament instability, medial or lateral
DESCRIPTION- Fingers are stabilized and supported. Varus or valgus stress applied to the joint (proximal or distal interphalangeal) to test the integrity of the collateral ligaments
RESULT- The results are compared for laxity with those of the uninvolved hand, which is tested first.
Froment’s Sign
PURPOSE- Identify ulnar nerve dysfunction
DESCRIPTION- The patient attempts to grasp a piece of paper between the thumb and index finger
RESULT- When the examiner attempts to pull away the paper, the terminal phalanx of the thumb flexes because of paralysis of the adductor pollicis muscle, indicating a positive test. If, at the same time, the metacarpophalangeal joint of the thumb hyperextends, the hyperextension is noted as a positive Jeanne’s sign. Both tests, if positive, are indicative of ulnar nerve paralysis
Wartenberg Sign
PURPOSE- Identify ulnar nerve neuropathy
DESCRIPTION- The patient sits with his or her hands resting on the table. The examiner passively spreads the fingers apart and asks the patient to bring them
together again.
RESULT- Inability to squeeze the little finger to the remainder of the hand indicates a positive test for ulnar neuropathy
Hoffman’s sign
PURPOSE- Indicates upper motor neuron dysfunction
DESCRIPTION- The examiner holds the patient’s middle finger and briskly flicks the distal phalanx
RESULT- A positive sign is noted if the interphalangeal joint of the thumb of the same
hand flexes/adducts. The fingers may also flex.
Thumb Grind Test
PURPOSE- Identify degenerative joint disease in the metacarpophalangeal or metacarpotrapezial joint
DESCRIPTION- The examiner holds the patient’s hand with one hand and grasps the patient’s thumb below the metacarpophalangeal joint with the other hand. The examiner then applies axial compression and rotation to the metacarpophalangeal joint
RESULT- If pain is elicited, the test is positive and
indicative of degenerative joint disease in the
metacarpophalangeal or metacarpotrapezial joint
Murphy’s Sign
PURPOSE- Identify lunate dislocation
DESCRIPTION- The 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 and indicative of a lunate dislocation. Normally, the third metacarpal would project beyond (or further distally) the second and fourth metacarpals.
Tinel’s Sign
PURPOSE-Identify carpal tunnel compression of median nerve
DESCRIPTION- The examiner taps over the carpal tunnel at the wrist
RESULT- A positive test causes tingling or paresthesia into the thumb, index finger,
and middle and lateral half of the ring finger. Tinel sign at the wrist is indicative of a carpal tunnel syndrome.
Phalen’s Test
PURPOSE- Identify carpal tunnel compression of median nerve
DESCRIPTION- The examiner flexes the patient’s wrists maximally and holds this position for 1 minute by pushing the patient’s wrists together.
RESULT- Production of the patient’s symptoms is considered to be a positive test for carpal tunnel syndrome. The test may also involve flexing the wrist 60° before applying the pressure and whether symptoms are relieved when the examiner lets
go. The wrist flexion is felt to make the test more sensitive
Two-Point Discrimination Test
PURPOSE-To identify level of sensory innervation in hand
DESCRIPTION- The examiner uses a paper clip, two-point discriminator, or calipers to simultaneously apply pressure on two adjacent points in a longitudinal direction or perpendicular to the long axis of the finger; the examiner moves proximal to distal in an attempt to find the minimal distance at which the patient can distinguish between the two stimuli. Only the fingertips need to be tested. Normal discrimination distance recognition is less than 6 mm
Allen’s Test
PURPOSE- To identify vascular compromise
DESCRIPTION- The patient is asked to open and close the hand several times as quickly as possible and then squeeze the hand tightly. The examiner’s thumb and index finger are placed over the radial and ulnar arteries, compressing them. The patient then opens the hand while pressure is maintained over the arteries. One artery is tested by releasing the pressure over that artery to see if the hand flushes.
The other artery is then tested in a similar fashion.
