Special Test (Wrist & Hand)

Front 1

-Test for tight Retinacular (Collateral) ligaments
-Haines-Zancolli Test

Back 1

This test tests the structures around the proximal interphalangeal joint. The proximal interphalangeal joint is held in a neutral position while the distal interphalangeal joint is flexed by thee examiner. If the distal interphalangeal joint does not flex, the retinacular (collateral) ligaments or proximal
interphalangeal capsule are tight. If the proximal interphalangeal joint is flexed and the distal interphalangeal joint flexes easily, the retinacular ligaments are tight and the capsule is normal. During the test, the patient remains passive and does no active movements.

Front 2

Murphy's Sign

Back 2

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.

Front 3

Watson (Scaphoid Shift) Test

Back 3

The patient sits with the elbow resting on the table and forearm pronated. The examiner faces the patient. With one hand, the examiner takes the patient's wrist into full ulnar deviation and slight extension while holding the metacarpals. The examiner presses the thumb of the other hand against the distal pole of the scaphoid on the palmar side to prevent it from moving toward the palm while the fingers provide a counter pressure on the dorsum of the forearm. With the first hand, the examiner radially deviates and slightly flexes the patient's hand while maintaining pressure on the scaphoid. This creates a subluxation stress if the scaphoid is unstable. If the scaphoid (and lunate) are unstable, the dorsal pole of the scaphoid subluxes or "shifts" over the dorsal rim of the radius and the patient complains of pain, indicating a positive test. If the scaphoid subluxes with the thumb pressure when the thumb is removed, the scaphoid commonly returns to its normal position with a "thunk.." If the ligamentous tissue is intact, the scaphoid will normally move forward, pushing the thumb forward with it.

Front 4

Piano Keys Test

Back 4

The patient sits with both arms in pronation. The examiner stabilizes the patient's arm with one hand so that the examiner's index finger can push down on the distal ulna. The examiner's other hand supports the patient's hand. The examiner pushes down on the distal ulna as one would push down on a piano key. The results are compared with the nonsymptomatic side. A positive test is indicated by a difference in mobility
and the production of pain and/or tenderness. A positive test indicates instability of the distal
radioulnar joint.

Front 5

Axial Load Test

Back 5

The patient sits while the examiner stabilizes the patient's wrist with one hand. With the other hand, the examiner carefully grasps the patient's thumb and applies axial compression. Pain and/or crepitation indicate a positive test for a fracture of metacarpal or adjacent carpal bones or joint arthrosis. A similar test may be performed for the fingers.

Front 6

Thumb grind test

Back 6

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. If pain is elicited, the test is positive and indicative of degenerative joint disease in the metacarpophalangeal or metacarpotrapezial joint. Axial compression with rotation to any of the wrist and hand joints may also indicate positive tests to those joints for the same condition.

Front 7

Linscheid Test

Back 7

This test is used to detect ligamentous instability of the second and third carpometacarpal joints. The examiner supports the metacarpal shafts with one hand. With the other hand, the examiner pushes the metacarpal heads dorsally, then palmarly. Pain localized to the carpometacarpal joints is a positive test.

Front 8

Sitting Hands Test

Back 8

The patient places both hands on the arms of a stable chair and pushes off, suspending the body while using only the hands for support. This test places a great deal of stress in the wrist (and elbow; see elbow instability tests) and is too difficult to do in the presence of significant wrist synovitis or wrist pathology.

Front 9

Finkelstein Test

Back 9

The Finkelstein test is used to determine the presence of de Quervain's or Hoffmann's disease, a paratenonitis in the thumb. The patient makes a fist with the thumb inside the fingers The examiner stabilizes the forearm and deviates the wrist toward the ulnar side. A positive test is indicated by pain over the abductor pollicis longus and extensor pollicis brevis tendons at the wrist and is indicative of a paratenonitis of these two tendons. Because the test can cause some discomfort in normal individuals the examiner should compare the pain caused on the affected side with that of the normal side. Only if the patient's symptoms are produced is the test considered positive.

Front 10

Sweater Finger

Back 10

The patient is asked to make a fist. If the distal phalanx of one of the fingers does not flex, the sign is positive for a ruptured flexor digitorum profundus tendon It occurs most often to the ring finger.

Front 11

Test for extensor hood rupture

Back 11

The finger to be examined is flexed to 90° at the proximal interphalangeal joint over the edge of a table. The finger is held in position by the examiner. The patient is asked to carefully extend the proximal interphalangeal joint while the examiner palpates the middle phalanx. A positive test for a torn central extensor hood is the examiner's feeling little pressure from the middle phalanx while the distal interphalangeal joint is extending.

Front 12

Boyes Test

Back 12

This test also tests the central slip of the extensor hood. The examiner holds the finger to be examined in slight extension at the proximal interphalangeal joint. The patient is then asked to flex the distal interphalangeal joint. If the patient is unable or has difficulty flexing the distal interphalangeal joint, it is considered a positive test.

Front 13

Bunnel – Littler (Finochietto-Bunnel) Test

Back 13

This test tests the structures around the metacarpophalangeal joint. The metacarpophalangeal joint is held slightly extended while the examiner moves the if the capsule is tight. The patient remains passive during the test. This test is also called the intrinsic-plus test.

Front 14

Tinel's Sign (Wrist)

Back 14

The examiner taps over the carpal tunnel at the wrist. A positive test causes tingling or paresthesia into the thumb, index finger (forefinger), and middle and lateral half of the ring finger (median nerve distribution). Tinel's sign at the wrist is indicative of a carpal tunnel syndrome. The tingling or paresthesia must be felt distal to the point of pressure for a positive test. The test gives an indication of the rate of regeneration of sensory fibers of the median nerve. The most distal point at which the abnormal sensation is felt represents the limit of nerve regeneration.

Front 15

Phalen's (Wrist Flexion) Test

Back 15

The examiner flexes the patient's wrists maximally and holds this position for 1 minute by pushing the patient's wrists together. A positive test is indicated by tingling in the thumb, index finger, and middle and lateral half of the ring finger and is indicative of carpal tunnel syndrome caused by pressure on the median nerve.

Front 16

Reverse Phalen's (prayer) Test

Back 16

The examiner extends the patient's wrist while asking the patient to grip the examiner's hand. The examiner then applies direct pressure over the carpal tunnel for 1 minute. The test is also described by having the patient put both hands together and bringing the hands down
towards the waist while keeping the palms in full contact, causing extension of the wrist. Doing the test this way does not put as much pressure on the carpal tunnel. A positive test produces the same symptoms as those seen in Phalen's test and is indicative of pathology of the median nerve.

Front 17

Carpal Compression Test

Back 17

The examiner holds the supinated wrist in both hands and applies direct, even pressure over the median nerve in the carpal tunnel for up to 30 seconds. Production of the patient's symptoms is considered to be a positive test for carpal tunnel syndrome. This test is a modification of the reverse Phalen's test.

Front 18

Froment's Sign

Back 18

The patient attempts to grasp a piece of paper between the thumb and index finger. 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 pos1tJve test. If, at the same time, the metacarpophalangeal joint of the thumb hyperextends, the hyperextension is noted as a positive Jeanne's signY Both tests, if positive, are indicative of ulnar nerve paralysis.

Front 19

Egawa's Sign

Back 19

The patient flexes the middle digit and then alternately deviates the finger radialiy and ulnarly. If the patient is unable to do this, the interossei are affected. A positive sign is indicative of ulnar nerve palsy.

Front 20

Wrinkle (Shrivel) Test

Back 20

The patient's fingers are placed in warm water for approximately 5 to 20 minutes. The examiner then removes the patient's fingers from the water and observes whether the skin over the pulp is wrinkled. Normal fingers show wrinkling but denervated ones do not. The test is valid only within the first few months after injury.

Front 21

Allen Test (Circulation & Swelling)

Back 21

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. As an alternative technique, the examiner may use both hands, placing one thumb over each artery to compress the artery and placing the fingers on the posterior aspect of the arm for stability. 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. Both hands should be tested for comparison. This test determines the patency of the radial and ulnar arteries and determines which artery provides the major blood supply to the hand.

Front 22

Digit Blood Flow (Circulation & Swelling)

Back 22

To test distal blood flow, the examiner compresses the nail bed and notes the time taken for col or to return to the nail. Normally, when the pressure is released, color should return to the nail bed within 3 seconds. If return takes longer, arterial insufficiency to the fingers should be suspected. Comparison with the normal side gives some indication of restricted flow.

Front 23

Hand Volume Test (Circulation & Swelling)

Back 23

If the examiner is concerned about changes in hand size, a volunteer may be used. This device can be used to assess change in hand size resulting from localized swelling, generalized edema, or atrophy. Comparisons with the normal limb give the examiner an idea of changes occurring in the affected hand. Care must be taken when doing this test to ensure accurate readings. There is often a 10-mL difference between right and left hands and between dominant and non dominant hands. If swelling is the problem, differences of 30 to 50 mL can be noted.