TESTS
|
POSITION
OF THE HAND & WRIST
|
STRUCTURES
INVOLVED
|
DESCRIPTION
OF TEST BEING PERFORMED
|
| Murphy's Sign |
Ask the patient to make a
fist. |
Tests for dislocation of the
lunate. |
As the examiner, visually
inspect the dorsal aspect of the hand. Normally the
knuckle formed by the head of the third metacarpal is
more prominent and protrudes further distally as compared
to the knuckles of the second and fourth metacarpal
heads. If the knuckle of the third metacarpal head is
level with the knuckles of the second and fourth
metacarpal heads, the sign is positive and indicative of
a lunate dislocation. |
| Anatomical Snuffbox
Compression Test |
The patient should rest the
involved forearm on the table. Then, ask the patient to
extend the thumb so that these tendons become prominent. |
Pain in the anatomical
snuff-box is an indication of a scaphoid fracture. |
The anatomical snuff box is
formed by space between the abductor pollicis longus and
extensor pollicis brevis tendons on the radial border and
the extensor pollicis longus tendon on the ulna side. As
the examiner, you should then press in the anatomical
snuffbox, applying compression to the scaphoid navicular
bone. Pain with palpation of the snuffbox is indicative
of a scaphoid fracture, particularly if the patient also
has pain in the same area with passive wrist
hyperextension. |
| Finkelstein's Test |
The patient sits with the
forearm supported on the table in a neutral position. The
hand should be free to hang over the table edge. Instruct
the patient to make a fist with the thumb inside the
fingers, deviating the wrist to the ulnar side. |
Determines presence of
tenosynovitis (De Quervain's disease or Hoffman's
disease) in the abductor pollicis longus and the extensor
pollicis brevis tendons of the thumb. |
You may accentuate the test
by using one hand to stabilize the distal forearm while
placing your other hand over the fist's radial side to
push the wrist into further ulnar deviation. This
maneuver will cause a stretching in these tendons which
is painful if tenosynovitis is present. Additional
positive findings may be accomplished by asking the
patient to begin with the wrist in full ulnar deviation
and then to actively abduct or radially flex the wrist
against your manual resistance. |
| Boutonniere Deformity Test |
Position the patient with
the forearm in pronation and the hand relaxed on the
table surface. |
Assesses central slip
integrity of the extensor tendon at the PIP joint. |
Grasp the proximal phalanx
and stabilize the metacarpophalangeal joint in extension.
Instruct the patient to actively extend the P.I.P. joint.
If the patient is unable to actively extend the P.I.P.
joint, an avulsion of the extensor tendon central slip is
indicated. This represents a boutonniere deformity, which
is characterized by hyperextension of the D.I.P. joint
with the P.I.P. joint assuming a position of flexion. You
should note that a similar deformity may occur from a
pseudo boutonniere deformity which results from a flexion
contracture of the P.I.P. due to volar capsule injury. A
patient with a pseudo boutonniere deformity will be
unable to extend the P.I.P. joint but will retain the
ability to flex the D.I.P. joint. (Pause) When performing
the boutonniere deformity test ask the patient to flex
the D.I.P. joint while you maintain extension of the
P.I.P. joint. If the patient cannot extend the P.I.P.
joint but can actively flex the D.I.P. joint, a pseudo
boutonniere deformity is indicated. |
| Mallet Finger Test |
Position the patient with
the forearm in pronation and the hand relaxed on the
table surface. |
Assesses extensor tendon
integrity at the DIP joint. |
Isolate the tendon by
holding the involved finger at the middle phalanx. Begin
with the D.I.P. joint relaxed in flexion. Instruct the
patient to extend the D.I.P. joint. Inability to extend
the D.I.P. joint is indicative of extensor tendon
avulsion at its attachment on the base of the distal
phalanx. |
| Flexor Digitorum
Superficialis Test |
Position the patient with
the forearm in supination and the hand relaxed on the
table surface. |
Assesses flexor digitorum
superficialis tendon function. |
To isolate the involved
tendon, hold the patient's fingers in extension, except
for the one being tested. Then have the patient flex the
involved finger at the P.I.P. joint. If the patient can
actively flex the P.I.P. joint, the tendon is intact. If
not, the tendon may be cut or ruptured |
| Flexor Digitorum Profundus
Test |
Position the patient with
the forearm in supination and the hand relaxed on the
table surface |
Assesses flexor digitorum
profundus tendon function. |
Isolate the tendon by
holding the patient's fingers in extension, except for
the involved finger. You should further isolate the
D.I.P. joint by maintaining the M.C.P. and P.I.P. joints
of the affected finger in full extension. Then have the
patient flex the finger in question at the D.I.P. joint.
If the patient can actively flex the D.I.P. joint, the
tendon is intact. If not, the tendon may be cut or
ruptured. |
| Phalen's Test or Wrist Press
Test |
Instruct the patient to flex
both shoulders and elbows approximately 90 degrees. Then
ask the patient to flex both wrists so that the dorsal
surface of both hands can be placed against one another. |
Detects carpal tunnel
syndrome. |
The patient should hold this
maximally flexed position for at least one minute. After
approximately one minute, tingling or numbness in the
median nerve distribution over the involved palmar
surface indicates the presence of carpal tunnel syndrome. |
| Pip & Dip Collateral
Ligament Tests (These tests may be repeated in similar
fashions to assess the collateral stability of the Distal
Interphalangeal Joints or D.I.P. Joints.)
|
Position the patient so that
the pronated forearm and hand are supported in a relaxed
position on the table. |
Assesses the ulnar
collateral ligaments of the finger joints |
Grasp the medial and lateral
aspect of the proximal phalanx with your thumb and index
finger. Use the thumb and index finger of your other hand
to grip the medial and lateral aspect of the intermediate
phalanx. While stabilizing the proximal phalanx with one
hand, maintain the joint in 15 to 20 degrees of flexion.
Use your other hand to radially distract the intermediate
phalanx which stresses the ulnar collateral ligament of
the proximal interphalangeal joint. While applying the
stress, visualize and feel for abnormal opening of the
joint as compared to the uninvolved joint of the other
hand. Normally, there should be a slight opening with a
firm end point. The absence of a firm end point
accompanied by associated sensations of pain or
instability indicates a sprain of the ulnar collateral
ligament. |
| (These tests may be repeated
in similar fashions to assess the collateral stability of
the Distal Interphalangeal Joints or D.I.P. Joints.) |
Position the patient so that
the pronated forearm and hand are supported in a relaxed
position on the table. |
Assesses the radial
collateral ligaments of the finger joints |
This same test may then be
reversed by distracting the intermediate phalanx ulnarly
to stress the radial collateral ligament. Again, maintain
the joint in 15 to 20 degrees of flexion while
stabilizing the proximal phalanx with one hand. Use the
other hand to ulnarly distract the intermediate phalanx
which stresses the radial collateral ligament of the
proximal interphalangeal joint. While applying the
stress, visualize and feel for abnormal opening of the
joint as compared to the uninvolved joint of the other
hand. Again, there should be a slight opening with a firm
end point. The absence of a firm end point accompanied by
associated sensations of pain or instability indicates a
radial collateral ligament sprain. |
| MCP Collateral Ligament Test |
Position the patient so that
the pronated forearm and hand are supported in a relaxed
position on the table surface. To enhance examination and
visualization, ask the patient to slightly flex the
uninvolved fingers further into flexion than the involved
finger. |
Assesses the ulnar
collateral ligaments of the metacarpophalangeal joints. |
For stabilization, you
should grasp the distal aspect of the metacarpals. Use
the thumb and index finger of your other hand to grip the
medial and lateral aspect of the proximal phalanx and to
maintain the joint in 30 degrees of flexion. Use your
thumb and index finger to radially distract the proximal
phalanx which stresses the ulnar collateral ligament of
the metacarpophalangeal joint. While applying the stress,
visualize and feel for abnormal opening of the joint as
compared to the uninvolved joint of the other hand.
Normally, there should be a slight opening with a firm
end point. The absence of a firm end point accompanied by
associated sensations of pain or instability indicate an
ulnar collateral ligament sprain. |
| |
Position the patient so that
the pronated forearm and hand are supported in a relaxed
position on the table surface. To enhance examination and
visualization, ask the patient to slightly flex the
uninvolved fingers further into flexion than the involved
finger. |
Assesses the radial
collateral ligaments of the metacarpophalangeal joints. |
This same test may then be
reversed by distracting the proximal phalanx ulnarly to
stress the radial collateral ligament. Again maintain the
joint in 30 degrees of flexion while stabilizing the
metacarpals with one hand. Use your other hand to ulnarly
distract the proximal phalanx which stresses the radial
collateral ligament of the metacarpophalangeal joint.
While applying the stress, visualize and feel for
abnormal opening of the joint as compared to the
uninvolved contralateral joint. Again, there should be a
slight opening with a firm end point. A sprain of the
radial collateral ligament is indicated by the absence of
a firm end point accompanied by associated sensations of
pain or instability. |
| Gamekeeper's Thumb Test |
Position the patient with
the forearm in neutral and the hand supported in a
relaxed position on the table surface. |
Assesses ulnar collateral
ligament stability at the thumb's metacarpophalangeal
joint. |
Grasp the medial and lateral
aspect of the first metacarpal with your thumb and index
finger. Use the thumb and index finger of your other hand
to grip the medial and lateral aspect of the proximal
phalanx, maintaining the joint in extension. Apply ulnar
stress to the joint by abducting the proximal phalanx.
While applying the stress, visualize and feel for
abnormal opening of the joint as compared to the
contralateral thumb. Normally, there should be a slight
opening with a firm end point. The absence of a firm end
point accompanied by associated sensations of pain or
instability indicate a sprain of the ulnar collateral
ligament. |
| Tinel's Sign at the Wrist |
Position the patient with
the forearm in supination and the hand relaxed on the
table surface. |
Detects carpal tunnel
syndrome. |
Use your index finger to tap
over the carpal tunnel at the wrist. A positive test
results when the tapping causes tingling or paresthesia
in the area of the median nerve distribution, which
includes the thumb, index finger, and middle and lateral
half of the ring finger. A positive Tinel's sign at the
wrist indicates carpal tunnel syndrome. |
| Bunnel-Littler Test |
Position the patient with
the forearm in pronation and the hand relaxed on the
table. |
Evaluates the tightness of
the hand's intrinsic muscles. |
To perform the test, hold
the metacarpophalangeal joint in a few degrees of
extension and move the proximal interphalangeal joint
into flexion. If, in this position, the P.I.P. joint can
be flexed, the intrinsic muscles are not tight and are
not limiting flexion. |
| Retinacular Test |
Position the patient with
the forearm in pronation and the hand relaxed on the
table surface. |
Verifies the tightness of
the retinacular ligaments. |
To conduct the test, hold
the P.I.P. joint in full extension as you try to move the
D.I.P. joint into flexion. If the joint does not flex,
limitation is due to either contracture of the joint
capsule or to retinacular tightness. To distinguish
between these two, flex the proximal interphalangeal
joint slightly to relax the retinaculum. If the distal
interphalangeal joint then flexes, the retinacular
ligaments are tight. If the joint does not flex, the
distal interphalangeal joint capsule is probably
contracted. |
| Allen Test |
Instruct the athlete to make
a tight fist and open it fully three or four times. |
This test determines whether
or not the radial and ulnar arteries are supplying the
hand to their full capacities. |
While the athlete is holding
the last fist, the evaluator places compression on either
the radial or ulnar artery. If upon release, blood fails
to return to the palm and fingers, an obstruction to the
artery's blood flow is possible. |
