Wrist Ortho Tests Flashcards
Ulnar and Radial collateral tests
Aim: assessing integrity of UCL + RCL
Action: Thumbs crossed over dorsal palm, radially deviating and then ulnar deviating.
+ve: RCL= Pain around anatomical snuffbox (radial fossa, lateral aspect of dorsum of hand, inferior to thumb). Need to be aware of scaphoid fracture
UCL= Pain over inferior radio-ulnar joint or Extensor Carpi Ulnaris tendon (base of 5th metacarpal, palmar aspect)
Scaphoid Shift Test
Aim: To assess movement of scaphoid or lunate bones, indicating instability or subluxation
Action: -Pt seated, elbow flexed, rested on table with palm facing Op.
-Op facing Pt, places thumb on palm of patients hand with fingers supporting dorsum of hand.
-Other hand grips scaphoid with thumb on anterior aspect, and fingers on dorsum of radius.
-Pressure applied anteriorly to scaphoid, Pt’s hand taken into ulnar deviation and extension to unload scapholunate articulation.
-Once Op’s thumb is fixed, Pt’s hand is placed into radial deviation and slight flexion to stress scapholunate articulation.
+ve: Excessive movement of scaphoid, associated pain/apprehension
Eichhoff’s/Finkelstein’s test
Aim: To assess for Quervain’s tenosynovitis (Abductor Pollicis Longus and Extensor Pollicis Brevis)
Action: Eichhoff’s sign: -Pt hand half pronated, clenching fist over top of thumb. Active movement of hand into ulnar deviation
Finkelstein’s: Thumb is not tucked, Op passively flexes thumb is same position
+ve: Pain over radial aspect of wrist as hand is moved into ulnar deviation
Tinel’s test
Aim: To assess for compression neuropathy of ulnar nerve in tunnel of Guyon, or median nerve in carpal tunnel
Action: Tap over tunnel of guyon or carpal tunnel for 30 seconds
+ve test: paraesthesia in ulnar or median nerve distribution
Phalen’s and reverse Phalen’a test
Aim: To assess for carpal tunnel syndrome by compressing (Phalen’s) or stretching (reverse Phalen’s) the median nerve in the carpal tunnel
Action: -Phalen’s: Patient takes wrists into FULL active flexion and pushes dorsal surfaces together
-Reverse: Wrists are taken into FULL extension and palmar aspects are placed together (praying)
+ve: Pain and paraesthesia in median nerve distribution of hand (palmar surface, 2nd,3rd, and half of 4th phalange, distal half on dorsal side. As well as most of the palmar thumb, with dorsum distal half of thumb).
