Hand Orthopedic Tests
Anterior Aspect
Thenar Eminence
Antero-Lateral aspect of the hand in anatomical
position.
Three muscles that move the thumb:
Abductor pollcis brevis, opponens pollicis, and flexor
pollicis.
Innervated by a branch of the median nerve.
Prolonged median nerve compression in the carpal
tunnel may cause the muscles to atrophy.
Thenar Eminence Palpation
Palpate the thenar eminence.
Look for atrophy in comparison to the opposite hand.
If atrophy is present with pain and paresthesia along
the medial nerve distribution, suspect compression of
the median nerve in the carpal tunnel.
Thenar Eminence
Hypothenar Eminence
Antero-medial aspect of the hand.
Three muscles:
Abductor digiti minimi, opponens digiti minimi, and
flexor digiti minimi.
Innervated by a branch of the ulnar nerve.
Prolonged compression of the ulnar nerve in Guyon’s
tunnel or more proximally in the extremity can cause
muscle atrophy.
Hypothenar Eminence
Palpation
Palpate the hypothenar eminence.
Look for hypertrophy or atrophy in comparison to the
opposite hand.
Atrophy may indicate compression of the ulnar nerve
in the tunnel of Guyon or more proximally in the
extremity.
Hypothenar Eminence
Posterior Aspect
Extensor Tendons
The extensor mechanism consists of ligaments, fascial
bands, and tendons.
They run along the entire length of the posterior aspect
of the hand and digits.
Trauma can strain or rupture the tendons.
Rheumatoid arthritis can displace the tendons.
Extensor Tendon Palpation
With the patient’s fingers and wrist extended, palpate
the length of each tendon of the extensor digitorum
communis from the base of the wrist to the proximal
phalanx.
Note tenderness, cysts, or loss of continuity of the
tendons.
Tenderness and displacement – rheumatoid arthritis.
Extensor Tendon Palpation
Loss of continuity after trauma – rupture of tendon
Small cysts may develop between the 2nd and 3rd
metacarpal bones.
Extensor Tendons
Metacarpals and Phalanges
The metacarpal bones and phalanges are easily
palpable from the posterior aspect.
Held together by ligaments and joint capsules.
Susceptible to traumatic fractures.
Common site for rheumatoid arthritis.
Palpation of Metacarpals and
Phalanges
Palpate each individual digit and metacarpal bone.
Look for tenderness, swelling, temperature differences,
and bony nodules.
Tenderness and swelling after trauma – fracture.
Swelling around the joint capsule – inflammatory
process such as rheumatoid arthritis.
Bony nodules (Heberden’s nodes) – osteoarthritis.
Palpation of Metacarpals and
Phalanges
Joint Instability
The interphalangeal joints are the most common site
of joint injuries to the hand.
Joint stability is maintained by the collateral ligaments
and the volar plate (three sided box around the joints).
The index and little finger are the most affected.
Joint instability is usually due to dislocation.
Varus and Valgus Stress Test
Procedure: Grasp the joint with a pinch grip and with
the other hand grasp the adjoining bone. Apply varus
and valgus stress to the joint.
Positive Test: If pain is elicited, suspect a capsule
sprain, subluxation or dislocation. Laxity could be a
tear to the joint capsule or collateral ligaments.
Varus and Valgus Stress Test
Thumb Ulnar Collateral
Ligament Laxity Test
Procedure: Carpometacarpal joint in extension.
Stabilize the metacarpal with a pinch grip. With the
opposite hand, grasp the proximal phalanx and push
the phalanx radially. Repeat in flexion.
Positive Test: When the thumb is fully extended, it
normally has 6 degrees of laxity. Greater than 6
degrees – the ulnar collateral ligament and volar plate
are damaged. Lax in flexion – ulnar collateral ligament
is damaged. No damage in flexion and greater than 30
degrees in extension, damage is limited to volar plate.
Thumb Ulnar Collateral
Ligament Laxity Test
Joint Capsule Tests
If the joint capsules are tight, they may have decreased
joint motion.
Limitations of the intrinsic muscles of the hand or tight
collateral ligaments.
Rheumatoid arthritis and osteoarthritis can cause this.
If the joint capsules are loose, they may have increased
joint motion.
Bunnel-Littler Test
Procedure: Instruct the patient to extend the MCP
joint slightly. Attempt to move the proximal
interphalangeal joint into flexion. Repeat with the
joint in flexion.
Positive Test: If the joint does not flex with the MCP
in slight extension – tight intrinsic muscle or
contracture of the joint capsule. If the joint fully flexes
with the MCP in flexion – the intrinsic muscles are
tight. Positive test indicates an inflammatory process
such as rheumatoid arthritis or osteoarthritis.
Bunnel-Littler Test
Tendon Instability
Tendon instability may be caused by vascular
impairment, tenosynovitis, overstretch, or trauma.
Trauma to the forearm may injure one or more of the
long tendons, which originate in the forearm and flex
and extend all of the joints of the fingers.
Profundus Test
Procedure: Instruct the patient to flex the suspected
distal phalanx while you stabilize the proximal phalanx.
Positive Test: Inability to flex the distal phalanx
indicates a divided flexor digitorum profundus tendon.
Profundus Test
Flexor and Extensor Pollicis
Longus Test
Procedure: Stabilize the proximal phalanx of the
thumb. Instruct the patient to flex and extend the
distal phalanx.
Positive Test: Inability to flex the digit – injured flexor
pollicis longus. Inability to extend the digit – injured
extensor pollicis longus.
Flexor and Extensor Pollicis
Longus Test
Extensor Digitorum
Communis Test
Procedure: With the fingers flexed, instruct the
patient to extend the fingers.
Positive Test: Inability to extend any of the fingers
indicates an injury to that particular portion of the
extensor digitorum communis tendon.
Extensor Digitorum
Communis Test