The Wrist, Hand, & Fingers: Special Tests
Special tests
 Fractures
 Ligamentous stress tests
 Joint play (glides)
 Provocation
 Neurological
 Vascular
Fractures
Long bone compression test
 Patient: Relaxed with joints in neutral
 Examiner: Stabilize above structure being tested
 Action: Apply
load
 Positive: Pain, crepitus
 Pathology: Fracture
 Notes: Can perform
for
distal phalanx fractures
Ligamentous stress tests
 remember…
 Tests the
of ligaments by
recreating the injury mechanism
 Stabilize proximal,
 Hand placement should be as close to joint being
tested as possible
 Graded as 1st, 2nd, 3rd degree with the use of +
and Wrist joint
 Valgus =
 Varus = RCL
1st MP joint
 Valgus = UCL
 Varus =
IP joints
 Valgus = UCL
 Varus = RCL
Joint play (glides)
Glides
 Patient: Sitting; Elbow flexed to 90˚, forearm
, & fingers in relaxed position
 Examiner: Sitting or standing lateral to patient
 One hand grasps distal radius
 Other hand grasps proximal carpal row
 Action:
force applied gliding
distal segment
 Positive: Pain or significant laxity compared
bilaterally
 Pathology: Sprain of collateral or intercarpal
ligaments
 Trauma to
 Note: Decreased glide may indicate adhesions or
capsular stiffness
 May also perform carpal (intercarpal)
glides
Notes
Provocation
Watson test
 Patient: Seated w/elbow flexed & supported on
table
 Hand/forearm point up
(
)
 Examiner: In font of patient
 Action: Examiner’s thumb applies
pressure to the distal pole of the scaphoid &
then moves wrist from UD to RD
 Positive: Reproduction of pain & notable pop at
scapholunate articulation
 Pathology:
dislocation
 Note: May be painful to “normal” patient
 May not be performable in an acute
situation
Finkelstein’s test
 Patient: relaxed w/ neutral forearm
 Examiner: not active
 Action: flexes fingers around thumb (fist with
thumb inside), active hyper Positive: Pain over APL and EPB tendons
 Pathology: de Quervain’s syndrome
 Can be painful in normal people, must compare
bilaterally
Neurological
Tinel’s sign
 Patient: relaxed and comfortable w/forearm
 Examiner: lateral or anterior to patient
 One hand supporting forearm, wrist and
hand
 One hand free to administer test
 Action: firm tapping of carpal tunnel
 Positive: reproduction of S&S to the
sensory
distribution
 Pathology: carpal tunnel syndrome
Phalen’s test
 Patient: relaxed and comfortable
 Examiner: not active
 Action: forced
of
wrists w/ dorsum of hands together for 1 minute
 Positive: reproduction of S&S to the median
nerve sensory distribution
 Pathology: carpal tunnel syndrome (median
nerve)
The Wrist, Hand, & Fingers: Special Tests
Reverse phalen’s test
 Patient: relaxed and comfortable
 Examiner: not active
 Action: forced
of wrist
for 1 minute
 Positive: reproduction of S&S to the median
nerve sensory distribution
 Pathology: carpal tunnel syndrome (median
nerve)
 “
”
Vascular
Allen test
 Patient: relaxed w/supinated forearms
 Examiner: lateral to patient
 One thumb over radial artery
 Other thumb over ulnar artery
 Actions:
 Patient opens and closes hand rapidly
 Examiner
radial
and ulnar arteries with thumbs
 Patient opens hand
 Examiner releases one artery watching
for immediate flush of hand
 Repeat to test other artery
 Positive: slow circulatory refill (check bilaterally)
 Pathology: radial or ulnar artery insufficiency
Notes