Sports Medicine II
Hand and Wrist Special Tests
Name _______________________
Valgus and Varus Stress Testing of the Wrist
Patient Position
Sitting, elbow flexed to 90°, forearm pronated, and the fingers assuming the relaxed
position
Examiner Position
Sitting or standing lateral to the wrist being tested.
Procedures
1. Grasp distal forearm with one hand and the metacarpals with the other
2-A. Apply a valgus stress, radially deviating the wrist (UCL)
2-B. Apply a varus stress, ulnarly deviating the wrist (RCL)
Positive Test
Pain or laxity compared with the same ligament on the opposite wrist
Implications
Stretching or tearing of the UCL or RCL
Wrist Glide Tests
Patient Position
Sitting, elbow flexed to 90°, forearm pronated, and the fingers assuming the relaxed
position of flexion
Examiner Position
Sitting or standing lateral to the wrist being tested
Procedures
1. One hand grips the distal radius and the other hand grasps the proximal carpal row.
2. A shear force is applied to the wrist by gliding the distal segment in a radial and ulnar
direction and then in a volar and dorsal direction.
Positive Test
Pain or significant change in glide compared with the opposite side
Implications
Tear or stretching of the collateral or intercarpal ligaments or trauma to the triangular
fibrocartilage. Decreased glide may indicate adhesions and capsular stiffness after injury
or surgery.
Valgus and Varus Stress Testing of the Interphalangeal Joints
Patient Position
Sitting or standing, joint being tested is in extension
Examiner Position
Standing in front of the patient, stabilizing the phalanx proximal to the joint being tested
Procedures
1. Examiner grasps the phalanx distal to the joint being tested
2. Apply a valgus stress and then a varus stress
Positive Test
Increased gapping, compared with the same motion on the same finger of the opposite
hand, pain
Implications
Collateral ligament sprain
Test for Laxity of the Collateral Ligaments of the Thumb
Patient Position
Sitting or standing
Examiner Position
Standing in front of the patient
Procedures
1. Examiner stabilizes the first metacarpal with one hand and its proximal phalanx with
the other.
2. While stabilizing the first metacarpal with the thumb slightly abducted and extended,
the examiner applies a valgus stress to the ulnar collateral ligament.
3. Test is repeated with the joint in varying degrees of flexion to evaluate the dorsal
capsule of the joint.
Positive Test
The ulnar side of the first metacarpophalangeal joint gaps farther than the uninjured side
or the patient describes pain (or both)
Implications
Stretching or tearing of the ulnar collateral ligament
Phalen’s Test
Patient Position
Sitting or standing
Examiner Position
Standing in front of the patient
Procedures
1. Patient places dorsal aspect of both hands in full contact so that both wrists are
maximally flexed.
2. Apply a steady compressive force through the subject’s forearms so that the wrists are
maximally flexed for 1 minute.
Positive Test
Numbness and tingling in the fingers (due to compression of median nerve)
Implications
Carpal Tunnel Syndrome
Finkelstein’s Test
Patient Position
Sitting or standing
Examiner Position
Standing in front of patient
Procedures
1. Patient makes a fist around the thumb.
2. Examiner grasps the patient’s forearm and fist with the patient’s thumb in the
examiner’s thenar eminence.
3. While stabilizing the patient’s forearm, ulnarly deviate the patient’s wrist.
Positive Test
Pain over the abductor pollicis longus and extensor pollicis brevis tendons
Implications
Tenosynovitis (de Quervain’s disease)
Tap Test
Patient Position
Sitting or standing
Examiner Position
In front of patient
Procedures
1. Patient extends affected finger.
2. Examiner applies a firm tap to the end of the finger being tested.
Positive Test
Pain
Implications
Fracture
Compression Test
Patient Position
Sitting or standing
Examiner Position
In front of patient
Procedures
1. Examiner holds the distal phalanx and applies compression along the long axis of the
bone of the finger being tested.
Positive Test
Pain
Implications
Fracture
Tinel’s Sign
Patient Position
Sitting with hand palm up on table
Examiner Position
Sitting beside patient
Procedures
1. Examiner taps on the volar aspect of the subject’s wrist over the area of the carpal
tunnel.
Positive Test
Tingling, paresthesia, or pain by the subject in the area of the thumb, index finger, middle
finger, and radial one-half of the ring finger.
Implications
Carpal Tunnel Syndrome, compression of the median nerve
Murphy’s Sign
Patient Position
Sitting or standing
Examiner Position
Standing in front of the subject
Procedures
1. Subject makes a fist.
2. Examiner notes the position of the third metacarpal.
Positive Test
Third metacarpal is level with second and fourth metacarpal
Implications
Dislocated lunate