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ORTHOPEDIC TESTS-WRIST, HAND ELBOW
(NPLEX)
ROM
Wrist
Elbow
Extension
Flexion
80
Radial Deviation
Ulnar Deviation 30
70
Flexion
20
Fingers
Extension
Flexion
Abduction
Adduction
Extension
135 +
Pronation
Supination
0-5
90
90
Thumb
30-45
90
Abduction
Adduction
70
0
20
0
1) Phalen's Sign
Procedure: The wrists are held together in complete flexion for 30-60 seconds. The sign is
positive if there is discomfort, numbness, tingling paresthesia.
Significance: Median nerve compression as in Carpal Tunnel Syndrome.
2) Tests for Ligamentous Stability
A) Flexor Digitorum Superficialis Test
Procedure: Hold the patient's fingers in extension - except for finger being tested. Instruct patient
to flex finger in question at the proximal interphalangeal joint. If he can not, the tendon is either
cut or absent.
B) Flexor Digitorum Profundus Test
Procedure: Isolate the distal interphalangeal joint by stabilizing the metacarpophalangeal and
interphalangeal joints in extension. Ask the patient to flex his finger at the distal interphalangeal
joint. If he can not - then tendon may be cut or the muscle denervated.
C) Assess the Stability of the Medial and Lateral Collateral Ligaments of the Elbow
Procedure: The examiner cups the posterior aspect of the patients elbow in one hand and holds
the wrist with the other hand. Instruct the patient to flex his elbow a few degrees as you force his
arm laterally, producing a valgus stress on the joint's medial side. Note any gaping medially.
Reverse the direction and push the forearm medially, producing a varus stress to the elbow's
lateral side. Inspect for gaping laterally.
3) Tinel's Sign
Procedure: Tap the area of the nerve in the groove between the olecranon and the medial
epicondyle. If positive there will be a tingling sensation down the forearm to the ulnar distribution
in the hand.
Significance: Neuroma
This test can be done along the course of an injured nerve to differentiate between the complete
and partial peripheral nerve interruption.
4) Tennis Elbow Test/Cozen Test
Procedure: Stabilize the patient's forearm and instruct him to make a fist and extend his wrist.
Apply pressure with your hand to the Dorsum of his fist to attempt to force his wrist into flexion. If
positive, the patient will experience pain at the lateral epicondyle.
Ortho Tests-Arm
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5) Bunnel-Littler Test
Procedure: To test the tightness of the intrinsic muscles, hold the metacarpophalangeal joint in a
few degrees of flexion. Try to move the proximal interphalangeal joint into the flexion. If the
proximal interphalangeal joint can be flexed, the intrinsics are not tight and aren't limiting flexion.
If it can't be flexed = tight intrinsics or joint contractures.
To distinguish between the intrinsic muscle tightness and joint capsule contractures, let the
involved finger flex a few degrees at the metacarpophalangeal joint and move the proximal
interphalangeal joint into flexion. If the joint is now capable of full flexion = tight intrinsic. If the
joint won't flex completely = proximal interphalangeal joint capsule contractures.
Significance: To evaluate the tightness of the intrinsic hand muscles and to determine whether
flexion limitations in the proximal interphalangeal joint is due to tightness of the intrinsic or to joint
capsule contractures.
6) Retinacular Test
Procedure: Hold the proximal interphalangeal joint in neutral position and try to move the distal
interphalangeal joint into flexion. If the joint does not flex = joint capsule contractures or due to
retinacular tightness. To distinguish between these two, flex the proximal interphalangeal joint
slightly to relax retinaculum. IF the distal interphalangeal joint flexes = the retinacular ligaments
are tight. If the joint doesn't flex, the distal interphalangeal joint capsule is probably contracted.
7) Allen Test
Procedure: Have patient open and close his fist several times and then squeeze his fist tightly so
that the venous blood is forced out of the palm. Place your thumb over the radial artery and your
index and middle fingers over the ulnar artery. Press them and occlude them. With the vessels
occluded, have the patient open his fist. The hand should be pale. Release one of the arteries
while maintaining pressure on the other one. The hand should flush immediately. If is does not =
occlusion. The other artery should be tested similarly.
Significance: To test radial and ulnar arteries supplying the hand.
Ortho Tests-Arm