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Wrist special tests
| Question | Answer |
|---|---|
| Finkelstein's test purpose | Determine the presence of de Quervain disease, a paratenonitis in the thumb |
| Finkelstein's test description | Pt makes a fist with the thumb inside the fingers. The examiner stabilizes the forearm and deviates the wrist toward the ulnar side |
| Finkelstein's test results | Pain over the abductor pollicis longus and extensor pollicis brevis tendons at the wrist and is indicative of a paratenonitis of these 2 tendons |
| Bunnel-Littler test purpose | Identifies tightness in structures surrounding the MCP joint |
| Bunnel-Littler test description | MCP joint is held slightly extended while he examiner moves the proximal interphalangeal joint into flexion, if possible |
| Bunnel-Littler test result | Positive (inability to flex the proximal interphalangeal joint): tight intrinsic m or contracture of capsule. If MCP joints are slightly flexed, the proximal ICP flexes fully if intrinsice m are tight, but does not flex fully is capsule is tight. |
| Tight retinacular test purpose | Identify tightness around PIP joint |
| Tight retinacular test description | PIP joint held in neutral while the DIP is flexed by the examiner. If the DIP does not flex, the retinacular (collateral) lig or PIP capsule is tight. If the PIP is flexed and the DIP flexes easily, the retinacular lig are tight and the capsule is normal |
| Ligament instability test purpose | identify ligament instability, medial or lateral |
| Ligament instability test 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 |
| Ligament instability test results | Results are compared for laxity with those of the uninvolved hand which tested first |
| Froment's sign purpose | Identify ulnar nerve dysfunction |
| Froment's sign description | Pt attempts to grasp a piece of paper between the thumb and index finger |
| Froment's sign results | When attempts to pull away the paper, the thumb flexes b/c of paralysis of the adductor pollicis m.: positive test. If the MCP joint of the thumb hyperextends: positive Jeanne's sign. Both tests, if positive, are indicative of ulnar n paralysis. |
| Warenberg Sign purpose | Identify ulnar nerve pathology |
| Warenberg Sign description | Pt sits with hands resting on table. The examiner passively spreads the fingers apart and asks patients to bring them together agin. |
| Warenberg Sign result | Inability to squeeze the little finger to the remainder of the hand indicates positive test for ulnar pathology |
| Hoffman's sign purpose | indicates upper motor neuron dysfunction |
| Hoffman's sign description | Examiner holds the pt's middle finger and briskly flicks the distal phalanx. |
| Hoffman's sign results | Positive sign note if the interphalangeal joint of the thumb of the same hand flexes/adducts. Fingers may also flex |
| Thumb grind test purpose | Identify DJD in the metacarpophalangelal or metacarpotrapezial joint |
| Thumb grind test desription | The examiner holds the patient's hand with 1 hand and grasps the pt's thumb below the MCP joint with the other hand. The examiner applies axial compression and rotation tothe MCP joint. |
| Thumb grind test results | If pain is elicited, the test if positive, and indicative of DJD in the metacarpophalangeal or metacarpotrapezial joint |
| Murphy's sign purpose | identify lunate dislocation |
| Murphy's sign description | Pt asked to make a fist. If the head of the 3rd metacarpal is level with the 2nd and 4th metacarpals, the sign is positive and indicative of lunate dislocation. Normally, the 3rd metacarpal would project beyond/ distally the 2nd and 4th metacarpals |
| Tinel's sign purpose | Identify carpal tunnel compression of median nerve |
| Tinel's sign description | examiner taps over carpal tunnel at the wrist |
| Tinel's sign results | positive: tingling/paresthesia into thumb, index finger, middle, and lateral half of ring finger. Indicative of carpal tunnel syndrome |
| Phalen's test purpose | Identify carpal tunnel compression of median nerve |
| Phalen's test description | Examiner flexes patient's wrist maximally and holds the positive for 1 min by pushing the pt's wrist together |
| Phalen's test result | Production of symptoms: positive for carpal tunnel syndrome. Test may involve flexing the wrist 60 degrees before applying pressure and whether symptoms are relived when the examiner lets go. |
| 2 point discrimination test purpose | Identify level of sensory innervation in hand |
| 2 point discrimination test description | Use paper clip, 2-point discriminator, or calipers to simultaneously apply pressure on 2 adjacent points in a longitudinal direction/ perpendicular to long axis of finger. Examiner moves prox to distal to find minimal distance at which pt can distinguish |
| 2 point discrimination test normal | Only fingertips need to be tested. Normal discrimination distance recognition is less than 6mm |
| Allen's test purpose | To identify vascular compromise |
| Allen's test description | Pt asked to open & close the hand several times as quickly as possible, & then squeeze hand tightly. Examiner's thumb & index are placed over the radial & ulnar artieries. 1 artery is tested by releasing pressure over the artery to see if hand flushes. |
Created by:
ecosio
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