Wrist Special Tests

Question 1

Finkelstein Test

Answer 1

Tests for: de Quervain’s tenosynovitis

Make fist with thumb held inside fingers.
Ulnar deviate.

Positive: pain along tendons of AbPL and EPB

Question 2

Tinel’s Sign

Answer 2

Tests for: Carpal Tunnel Syndrome, median nerve involvement

Tap over carpal tunnel at wrist

Positive: tingling or paresthesia in D1-3, and/or lateral D4

Question 3

Phalen’s Sign

Answer 3

Test for: Carpal Tunnel Syndrome

Client strongly compressed back of hands together.
Wrists flexed, elbows horizontal
Hold for 60 seconds

Positive: Tingling, pain in D1-3, and/or lateral D4

Question 4

Reverse Phalen’s Sign

Answer 4

Test for: Carpal Tunnel Syndrome

Prayer position
Hold for 60 seconds

Positive: Tingling, pain in D1-3, and/or lateral D4

Use if lunate dislocated, or flexion unavailable

Question 5

How does Phalen’s work?

Answer 5

Puts maximum compression on structures in carpal tunnel, especially the median nerve.

Question 6

Allen test

Answer 6

Tests for: vascular efficiency of radial and ulnar arteries in the hand

Client opens and closes hand rapidly
Therapist occludes radial and ulnar arteries while hand closed
Client opens hand.
Therapist releases pressure over one of the arteries. Observes hand pink up.

Compares to other artery and to the other hand.

Question 7

Wrist Extension Ligamentous Stress Test

Answer 7

Tests for: sprain of palmar wrist ligaments, strain of flexor muscles, flexor strain, CTS

Pronate hand, stabilize proximal to wrist, take wrist into POP extension

Positive:

1. pain and hypermobility –> sprain of palmar RC ligaments
2. pain in flexor muscles –> strain
3. pain and dysesthesia in palm –> CTS

Question 8

Wrist Flexion Ligamentous Stress Test

Answer 8

Tests for: Sprain of dorsal wrist ligaments, strain of extensor muscles, CTS

Pronate hand, stabilize proximal to wrist, take wrist (and fingers) into POP flexion. KEep elbow extended

Positive:

1. pain and hypermobility –> sprain of dorsal RC ligaments
2. pain in extensor muscles –> strain
3. pain and dysesthesia in palm –> CTS

Question 9

Radial Ligamentous Stress Test

Answer 9

Tests for: sprain of Ulnar Collateral Ligament, strain of FCU, ECU

Supinate forearm. Stabilize proximal to wrist. POP radial deviation.

Positive:

1. pain and hypermobility –> UCL sprain
2. pain in ECU or FCE –> strain

Question 10

Ulnar Ligamentous Stress Test

Answer 10

Tests for: sprain of Radial Collateral Ligament, strain of radial deviators (ECRL, ECRB, FCR)

Supinate forearm. Stabilize proximal to wrist. POP ulnar deviation. (grip inside thumb; apply pressure against MCP of D2)

Positive:

1. pain and hypermobility –> RCL sprain
2. pain in ECRL, ECRB, FCR –> strain