SPECIAL TESTS FOR
THE WRIST AND HAND
SPECIAL TESTS FOR THE WRIST AND HAND
SPECIAL TEST:
Collateral Ligament Test of Fingers
STRUCTURE:
Collateral Ligament of MCP joint (can be repeated for PIP and DIP with finger in
extension).
POSITION:
The patient is seated with the wrist in neutral position; the MCP is in 90 degrees
of flexion (this tightens the collateral ligaments).. The therapist is standing/
sitting with the thumb of the operating hand on the radial side of the proximal
phalanx of patient’s digit.
APPLICATION:
POSITIVE SIGN:
REFERENCE:
Perform a varus force to phalanx distal to MCP; repeat with a valgus force.
Gapping/instability at MCP joint.
A.
B.
C.
Copyright © 1998 by The Ola Grimsby Institute • 1.800.646.6128
WRT • 3
SPECIAL TESTS FOR THE WRIST AND HAND
SPECIAL TEST:
STRUCTURE:
POSITION:
APPLICATION:
POSITIVE SIGN:
REFERENCE:
WRT • 4
Finger Fracture Percussion Test
Possible fracture of digit.
The patient is seated with the hand/forearm supported on a table and the finger
extended.The therapist is standing/sitting with the stabilizing hand supporting
the hand of the patient.
The operating hand performs a longitudinal tapping on tip of the patient’s
involved finger.
Pain with percussion.
G. p. 101
Copyright © 1998 by The Ola Grimsby Institute • 1.800.646.6128
SPECIAL TESTS FOR THE WRIST AND HAND
SPECIAL TEST:
STRUCTURE:
POSITION:
APPLICATION:
POSITIVE SIGN:
REFERENCE:
Figure A
Bunnel-Littler Test
Joint capsule, intrinsics
The patient is sitting.The therapist is standing/sitting
The therapist places the patient's metacarpophalangeal joint in slight extension.
The therapist moves the proximal interphalangeal joint into flexion. The
patient's metacarpophalangeal joint is then placed in slight flexion and the
therapist moves the interphalangeal joint into flexion.
Metacarpophalangeal joint in flexed position; test is positive when the
interphalangeal joint will not flex. If the metacarpophalangeal joint and
interphalangeal joint will not flex, then the intrinsic muscle is tight or there is a
contracture of the joint capsule. If the metacarpophalangeal joint is slightly flexed
and the proximal interphalangeal joint will flex then the intrinsics are tight. The
proximal phalangeal joint will not flex if the capsule is tight.
A. p. 190-191
B. p. 101-102
C. p. 189
Figure B
Copyright © 1998 by The Ola Grimsby Institute • 1.800.646.6128
WRT • 5
SPECIAL TESTS FOR THE WRIST AND HAND
SPECIAL TEST:
STRUCTURE:
POSITION:
APPLICATION:
POSITIVE SIGN:
Retinacular Test (Test for Tight Retinacular Ligaments)
Joint capsule/collateral ligaments
The patient is sitting. The patient remains passive throughout test. The therapist
is sitting or standing. The patient’s proximal interphalangeal joint is held in a
neutral position by the therapist. The therapist's thumb is on the palmar surface
of the proximal interphalangeal space. The therapist's index finger is on the
dorsal surface of the phalanx between the proximal and distal joint to maintain
neutral position.
The distal interphalangeal joint is flexed by the therapist.
Distal Interphalangeal joint does not flex because the retinacular (collateral)
ligaments or capsule is tight.
Second Part of Retinacular Test: (to differentiate between capsule or ligaments)
POSITION:
The patient is sitting.The therapist is sitting or standing.
APPLICATION:
The therapist flexes the proximal interphalangeal joint of the patient (to relax the
retinaculum). The therapist flexes the distal interphalangeal joint.
POSITIVE
SIGN:
Distal interphalangeal joint flexes Retinacular ligaments are tight and the capsule
is normal. If the distal interphalangeal joint does not flex then the capsule is
contracted.
REFERENCE:
WRT • 6
B. p. 102
C. p. 193
Copyright © 1998 by The Ola Grimsby Institute • 1.800.646.6128
SPECIAL TESTS FOR THE WRIST AND HAND
SPECIAL TEST:
STRUCTURE:
POSITION:
Flexor Digitorum Profundus Isolation Test (Distal Interphalangeal Tightness
Differentiation Test)
If there is no flexion at the distal interphalangeal joint occurs then the tendon can
either be cut or the muscle ( flexor digitorum profundus) is denervated.
The patient is sitting. The therapist is sitting or standing.
APPLICATION:
The therapist stabilizes the metacarpophalangeal and interphalangeal joints in
extension. The patient then flexes his finger at the distal interphalangeal joint.
POSITIVE SIGN:
If the distal interphalangeal joint flexion occurs then the tendon iS functional
(figure A). A positive test shows the distal interphalangeal joint does not flex
(figure).
REFERENCE:
Figure A
B. p. 100-101
Figure B
Copyright © 1998 by The Ola Grimsby Institute • 1.800.646.6128
WRT • 7
SPECIAL TESTS FOR THE WRIST AND HAND
SPECIAL TEST: Flexor Digitorum Superficialis Isolation Test
STRUCTURE: Flexor Digitorum Superficialis muscle and its attachments.
POSITION: The patient is sitting.The therapist is sitting or standing. Therapist positions the
patient's fingers in extension except for the finger to be tested.
APPLICATION: The patient flexes the finger being tested at the proximal interphalangeal joint.
POSITIVE SIGN: The proximal interphalangeal joint will not flex. The flexor digitorum
superficialis muscle is either lacerated or absent.
REFERENCE: B. p. 101
WRT • 8
Copyright © 1998 by The Ola Grimsby Institute • 1.800.646.6128
SPECIAL TESTS FOR THE WRIST AND HAND
SPECIAL TEST:
STRUCTURE:
POSITION:
APPLICATION:
POSITIVE SIGN:
REFERENCE:
Figure A
Finkelstein’s Test
Abductor pollicus longus and the extensor pollicus brevis.
The patient is seated with the hand pronated, while making a fist with the thumb
tucked inside the fist.The therapist is standing alongside the patient using one
hand to stabilize the patient’s forearm.
While stabilizing the wrist / forearm of the patient, passively gently force the
wrist into ulnar deviation.
Significant pain over the radial styloid which may indicate stenosing
tenosynovitis.
A. p. 198-199
B. p. 76-77
C. p. 189
Figure B
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WRT • 9
SPECIAL TESTS FOR THE WRIST AND HAND
SPECIAL TEST:
STRUCTURE:
POSITION:
Allen Test:
Patency of the radial and ulnar arteries.
The patient is sittingThe therapist is sitting/standing
APPLICATION:
The radial and ulnar arteries are tested separately. The test can determine which
artery supplies the most blood to the hand. The patient actively opens and closes
the hand several times as quickly as possible. The patient's hand is kept closed
tightly on the final squeeze. This allows for the venous blood to be removed
from the palm. The therapis'ts thumb is placed over the patient's radial artery
and occludes the artery. The therapist's index and middle finger are placed over
the patient's ulnar artery to occlude the artery simultaneously. The therapist
maintains the pressure over the arteries. The palm will appear pale. The patient
is then instructed to open his hand. The therapist releases 1 artery and maintains
pressure on the opposite artery. The test is repeated for the opposing artery. The
test is compared to the contralateral hand.
POSITIVE SIGN:
The hand remains pale or the hand flushes slowly. Normally the hand will flush
immediately.
REFERENCE:
Figure A
WRT • 10
A. p. 64-65
B. p. 102-103
C. p. 198
Figure B
Copyright © 1998 by The Ola Grimsby Institute • 1.800.646.6128
SPECIAL TESTS FOR THE WRIST AND HAND
SPECIAL TEST:
STRUCTURE:
POSITION:
Modified Allen Test for Digital Arteries
The patency of the digital arteries.
The patient is sitting. Therapist is sitting/standing.
APPLICATION:
The patient actively opens and closes the hand several times as quickly as
possible to remove the venous blood from the palm. The hand is kept tightly
closed on the final squeeze. The patient's hand is kept in a fist. The therapist
places his thumb and index finger on the sides of the base of the involved finger.
Pressure is applied by the therapist on the digital arteries, pressing the arteries to
the bone, occluding the arteries. The finger should be pale from the occlusion of
the arteries. The patient open his hand and pressure is released by the therapist
of one of the digital arteries. The test is repeated for the opposite digital artery of
the same finger. The test should also be repeated for the same finger of the
opposite hand.
POSITIVE SIGN:
The finger normally flushes when pressure is released from the artery. A positive
test would reveal a pale finger or a slow flushing affect.
REFERENCE:
Figure A
B. p. 103
Figure B
Copyright © 1998 by The Ola Grimsby Institute • 1.800.646.6128
WRT • 11
SPECIAL TESTS FOR THE WRIST AND HAND
SPECIAL TEST:
STRUCTURE:
POSITION:
Phalen Sign
Indicative of Carpal Tunnel Syndrome caused by pressure on median nerve.
The patient is sitting. The therapist is sitting or standing. The therapist positions
the patient’s wrist in maximal flexion, the dorsal surface of one wrist meets the
dorsal surface of the opposite wrist.
APPLICATION:
The patient maintains position of bilateral wrists in maximal flexion for one
minute.
POSITIVE SIGN:
Tingling in the thumb-index finger-middle finger-lateral half of ring finger.
REFERENCE:
WRT • 12
A. p. 120-121
B. p. 82-83
C. p. 194
Copyright © 1998 by The Ola Grimsby Institute • 1.800.646.6128
SPECIAL TESTS FOR THE WRIST AND HAND
SPECIAL TEST: Reverse Phalen Sign
STRUCTURE: Indicative of Carpal Tunnel Syndrome caused by pressure on median nerve.
POSITION: The patient is sitting. The therapist is sitting or standing. The therapist positions
the patient’s bilateral wrists in maximal extension with the palmar surface of
one wrist meeting the palmar surface of the opposite wrist.
APPLICATION: The patient maintains the position of bilateral wrists in maximal extension for
one minute.
POSITIVE SIGN:
Tingling in the thumb-index finger-middle finger-lateral half or ring finger.
REFERENCE: C. p. 194
Copyright © 1998 by The Ola Grimsby Institute • 1.800.646.6128
WRT • 13
SPECIAL TESTS FOR THE WRIST AND HAND
SPECIAL TEST:
STRUCTURE:
POSITION:
APPLICATION:
POSITIVE SIGN:
REFERENCE:
WRT • 14
Smith's Test
Indicative of Carpal Tunnel Syndrome caused by pressure on median nerve.
The patient is sitting with the middle digit flexed to the thumb.
The patient flexes the wrist holding the position 15 to 30 seconds.
Tingling in the thumb-index finger-middle finger-lateral half or ring finger.
A:
B:
C:
Copyright © 1998 by The Ola Grimsby Institute • 1.800.646.6128
SPECIAL TESTS FOR THE WRIST AND HAND
SPECIAL TEST:
STRUCTURE:
POSITION:
APPLICATION:
POSITIVE SIGN:
Tinnels Test
Indicative of Carpal Tunnel Syndrome caused by pressure on median nerve.
The patient is sitting the wrist in slight extension.
The therapist taps over the carpal tunnel.
Tingling in the thumb-index finger-middle finger-lateral half or ring finger.
REFERENCE:
C: p. 194
Copyright © 1998 by The Ola Grimsby Institute • 1.800.646.6128
WRT • 15
SPECIAL TESTS FOR THE WRIST AND HAND
SPECIAL TEST:
STRUCTURE:
POSITION:
Froment’s Pinch
Terminal phalanx of thumb will flex because of paralysis of the adductor pollicis
muscle. Ulnar nerve paralysis.
The patient is sitting. The therapist is sitting or standing.
APPLICATION:
Place a piece of paper between the patient’s index finger and thumb at the
level of the metacarpalphalangeal joints and have the patient squeeze hard.
The therapist pulls the paper.
POSITIVE SIGN:
Paper can be easily pulled out. The terminal phalanx of the thumb will flex.
Normal response in figure A, positive in figure B.
REFERENCE:
Figure A
WRT • 16
A. p. 208-209
C. p. 194-195
Figure B
Copyright © 1998 by The Ola Grimsby Institute • 1.800.646.6128
SPECIAL TESTS FOR THE WRIST AND HAND
SPECIAL TEST:
STRUCTURE:
Moberg’s Two Point Discrimination Test
The purpose of the test is to attempt to find the minimal distance which the
patient can determine between two stimuli. This distance is the Threshold for
Discrimination.
POSITION:
The patient is sitting with the hand supported by a hard surface. The therapist is
sitting or standing
APPLICATION:
The therapist simultaneously applies pressure on two adjacent points of the
patients fingertips with a paper clip, 2 point discriminator, or caliper. The
pressure is applied either in a longitudinal or perpendicular direction to the long
axis of the finger. The therapist must make sure the two points touch the skin
simultaneously. No blanching of the skin should occur when points are tested.
The distance between the two points should be increased or decreased
depending on the patients response. The patient shouldnot see the area being
tested.
POSITIVE SIGN:
Normal distance between two points:
less than 6 mm
-Fair distance between two points: 6 mm to 10 mm
-Poor distance between two points : 11 mm to 15 mm
This test can be useful in determining the discrimination necessary to perform
certain tasks:
-Winding a watch:
-Sewing:
-Handling precision tools:
-Gross tool handling:
REFERENCE:
6 mm discrimination
6-8 mm discrimination
12 mm discrimination
> 15 mm discrimination
C. p. 195
Copyright © 1998 by The Ola Grimsby Institute • 1.800.646.6128
WRT • 17
NOTES
WRT • 18
Copyright © 1998 by The Ola Grimsby Institute • 1.800.646.6128