Wrist/Hand Special Tests

Question 1

What 3 special tests are testing for neurological dysfunction?

Answer 1

1. Carpal compression test (median nerve compression test)
2. Froment’s Sign
3. Phalen’s Test

Question 2

What is the ulnar collateral ligament instability test?

What is injury to this joint referred to?

Answer 2

PT holds the thumb in extension and applies a valgus force to the MCP joint of the thumb.

This type of injury is referred to as gamekeeper’s or skier’s thumb

ULNAR COLLATERAL ON THE INSIDE OF THUMB - Closer to the ulna

Question 3

What is Allen’s Test for the hand?

Answer 3

• Pt opens and closes hands several times and then maintains a closed position.
• PT compresses radial and ulnar arteries
• Pt then relaxes hand and therapist releases pressure on ONE of the arteries while observing the color of the hand and fingers

Positive: delayed or absent flushing of radial or ulnar half of the hand which may be indicative of an occlusion

Question 4

What is the Bunnel-Littler Test?

Answer 4

• Pt sitting with MCP joint held in slight extension
• PT attempts to move the PIP joint into flexion

1. If the PIP joint does not flex with the MCP joint extended, there may be a tight intrinsic muscle or capsular tightness
2. If the PIP joint fully flexes with the MCP joint in slight flexion, there may be instrinsic muscle tightness without capsular tightness

Question 5

What is the Tight Retinacular Ligament Test?

Answer 5

-The PIP joint is held in an neutral position while the PT attempts to flex the DIP.

1. If the PT is unable to flex DIP the retinacular ligaments or capsule may be tight
2. If the PT is able to flex the DIP with the PIP in flexion, the retinacular ligaments may be tight and the capsule may be normal

Question 6

What is the Carpal Compression Test (median nerve compression test)?

Answer 6

The therapist holds the patients wrist with both hands and applies pressure over the median nerve in the carpal tunnel for 30 seconds.
-The test can also be performed by placing the patient’s wrist in 60 degrees of flexion before applying pressure.

Positive; pain or paresthesia in the median nerve distribution

Question 7

What is Froment’s Sign?

Answer 7

Patient is asked to hold a piece of paper between thumb and index finger. The PT attempts to pull teh paper away from the patient

Positive: the patient flexing the distal phalanx of the thumb due to ADDUCTOR POLLICIS muscle paralysis. If at the same time the pt hyperextends the MCP joint of the thumb, it is called Jeanne’s Sign. Both may indicate ULNAR nerve compromise.

Question 8

What is Phalen’s sign?

Answer 8

Pt maximally flexes wrists and it is held for 60 seconds.

Positive: tingling in the thumb, index, finger, middle finger, and lateral half of the ring finger which indicates MEDIAN NERVE compromise

Question 9

What is Finkelstein Test?

Answer 9

Pt is asked to make a fist with the thumb tucked inside the fingers. The PT stabilizes the patient’s forearm and ulnarly deviates the wrist.

Positive: pain over the abductor pollicis longus and extensor pollicis brevis tendons indicating TENOSYNOVITIS of the thumb (de Quervain’s disease)

Question 10

What is the Grind Test?

Answer 10

PT stabilizes the patient’s hand and grasps the patient’s thumb on the metacarpal. PT applies compress and rotation.

Positive: pain, could be degenerative joint of CMC

Question 11

What is Murphy Sign?

Answer 11

Pt asked to make a first

Positive: patients third metacarpal remaining level with the second and fourth. May indicate a dislocated LUNATE

MURPHY BEAT SOMEONE UP AND DISLOCATED THEIR LUNATE
-look at the metacarpal head

Question 12

What are two test in the hand testing for contracutre/tightness?

Answer 12

1. Bunnel-Littler Test

2. Tight retinacular ligament test