Part Three
Special Tests
1.
2.
3.
4.
5.
6.
7.
8.
Compression test
Flick/tap test
Percussion test
Collateral stress (wrist)
Collateral stress
(fingers)
Watson Clunk
Tinel’s sign
Digital Allen test
9. Phalen
10. Reverse Phalen
11. Murphy’s sign
12. DeQuervain’s/Finkelstein
13. Long Finger Flexion test
14. Paper/Froment sign
15. Bunnell-Littler test
Compression Test (fracture):
 Examiner begins by grasping pt’s hand and
compressing each digit along the long axis
 Complete on all digits
 Pain indicates a positive test for possible phalangeal
fracture
 Do not perform if an obvious deformity is present
Flick/Tap Test (fracture)
 Stabilize pt’s finger with one hand and “flick” or tap
the tip of pt’s finger with the index finger of the other
hand
 Repeat on all digits
 Pain indicates a positive test for possible fracture
Percussion Test (fracture)
 Stabilize pt’s hand with one hand and percuss pt’s
fingers independently with the index finger of the
other hand
 Repeat on all digits
 Pain indicates a positive test for possible fracture
Collateral Stress Test (wrist)
(capsular laxity):
 The examiner stabilizes the pt’s distal forearm with
one hand while grasping the pt’s hand with the other
 While holding the pt’s forearm in a neutral position,
the examiner then applies valgus and varus forces to
the pt’s wrist to test the integrity of the pt’s medial and
collateral wrist ligaments, respectively
Collateral Stress Test (fingers)
(laxity):
 The examiner stabilizes the pt’s finger with the thumb
and index finger of one hand and applies mild varus
and valgus force to each of the interphalangeal joints
with the thumb and index finger of the other hand,
looking for laxity or abnormal joint opening that may
be indicative of lateral and/or medial collateral
ligament sprain
 Repeat on all phalangeal articulations of all fingers
Watson Clunk Test (instability):
 The examiner stabilizes pt’s
distal radius and ulna with one
hand and grasps the pt’s
scaphoid bone with the thumb
and index finger of the other
 The examiner then attempts to
translate the pt’s scaphoid
anteriorly and posteriorly
 Dislocation and/or subluxation
indicates a positive test for
scaphoid instability
Tinel’s Sign (at wrist) neuritis):
 Examiner taps lightly over the pt’s
transverse carpal ligament, looking
for signs of paresthesia along the
distal-most distribution of the
median nerve
 **Note: reflex hammer not
required**
Digital Allen Test (arterial
compromise):
 The examiner instructs pt. to
rapidly open and close the hand 15
times
 As soon as the athlete finishes the
final repetition, the examiner
places his or her thumb over the
pt’s radial artery and index finger
over the pt’s ulnar artery
 If pt’s hand remains cyanotic until
after the examiner removes the
pressure, then the test is positive
for poor, impaired, and/or
depressed perfusion (circulation)
through the distal extremities
Phalen Test (CTS/neurologic
impairment):
 Position the patient with the
dorsal aspect of both hands in
full contact with both wrists
maximally flexed
 Instruct the patient to hold
the position for 1 minute
 Tingling or numbness
radiating into the fingers
(especially the palmar surface)
indicates a positive test for
median and/or radial nerve
impairment
Reverse Phalen Test (carpal tunnel
syndrome):
 Instruct pt to perform a Phalen test
with the wrists positioned in full
extension and the palms in full
contact
 “Prayer hands”
 Pt is instructed to hold the position
for 1 minute while the examiner
applies direct pressure over the
athlete’s carpal tunnel
 Tingling, numbness, and/or
paresthesia indicates a positive test
for carpal tunnel syndrome
Murphy’s Sign (lunate dislocation):
 Examiner instructs pt to
make a fist, then assesses
contour of MCP joints
 If third metacarpal is level
with second and fourth
metacarpals, lunate
dislocation is suspected
DeQuervain’s (Finkelstein ) Test
(DeQuervain’s disease):
 Instruct pt to abduct the thumb so that it
rests in the palm of the hand
 Pt is then instructed to wrap the fingers
over the thumb in order to make a fist
 Examiner then stabilizes the wrist with one
hand and applies a varus force to the wrist
 Sharp pain on the lateral aspect of the wrist
indicates a positive test for stenosing
tenosynovitis to the abductor pollicus
longus and/or the extensor pollicus brevis
tendon sheath(s)
Long Finger Flexion Test (tendon
rupture):
 Independently isolate each of the pt’s interphalangeal
joints, looking for obvious inability to flex which may
be indicative of muscular lesion and/or avulsion
 An inability to flex the DIP of any digit indicates a
positive test for flexor digitorum profundus lesion
 An inability to flex the PIP of any digit indicates a
positive test for flexor digitorum superficialis lesion
Paper Test /Froment’s Sign
(neurologic impairment):
 Pt is instructed to hold a
piece of paper between the 1st
and 2nd digits by forcefully
opposing those digits
 The examiner then attempts
to pull the paper out
 An inability to hold the
contraction and/or a weak
contraction indicates a
positive test for ulnar nerve
impairment
Bunnel-Littler Test (hypomobility):
 Examiner holds the pt’s MCP joint in slight extension while
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moving the PIP joint into flexion
If the PIP joint cannot be flexed, the test is positive for
tight intrinsic muscles or contracture of the joint capsule
The examiner then slightly flexes pt’s MCP joint while
moving the PIP into flexion again
If the PIP joint will flex, then the intrinsic muscles are tight
If the PIP joint will not fully flex, then the joint capsule is
tight
Repeat on all digits