Clinical Tests: Tinels, Phalens, Finkelstein.What are they

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Clinical Tests Tinels, Phalens,
Finkelstein.What are they?

• By William D. Moore, M.D.
• Orthopedic Surgeon

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Clinical Examination is Very Important

• The clinical examination of a patient along with
  their history is very important in forming a
  diagnosis and treatment plan.
• Diagnostic imaging must be correlated with
  clinical exam findings.

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Tests for Forearm, Wrists Hands

• Tinels Test
• Carpal Compression Test
• Finkelsteins Test

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Tinels Test

• The examiner taps over the carpal tunnel at the
  wrist. A positive test causes tingling or
  paresthesia into the thumb, index finger, and
  middle and lateral half of the ring.

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Tinels Test
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Carpal Compression Test

• The examiner holds the supinated wrist in both
  hands and applies direct, even pressure over the
  median nerve in the carpal tunnel for up to 30
  seconds.

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Carpal Compression Test
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Finkelsteins Test

• A proactive test in which flexion of the thumb
  and ulnar deviation of the wrist are used to
  elicit the pain of de Quervains tenosynovitis.

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Finkelsteins Test
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Test for the Shoulder Biceps

• Hawkins Impingement Test
• Neer Impingement Test
• Empty Can Test
• Cross-arm Adduction Impingement Test
• Speeds Test
• Yergasons Test

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Hawkins Impingement Test

• A test for rotator cuff impairment in which the
  shoulder is flexed 90 degrees and maximally
  internally rotated.

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Hawkins Impingement Reinforcement Test
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Neers Impingement Sign

• The production of pain by maximal passive forward
  flexion of the shoulder, considered a sign of
  rotator cuff impingement.

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Neers Impingement Sign
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Empty Can

• A resistive test for the shoulder, designed to
  isolate supraspinatus function as much as
  possible, performed with the shoulder in a
  position of 90 degrees abduction and maximal
  internal rotation in a plane 30 degrees anterior
  to the coronal plane.

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Empty Can
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Cross-arm Adduction Impingement Test

• This test uses the position of cross-arm or
  horizontal adduction to produce contact between
  the rotator cuff and biceps long-head tendon and
  the coracoacromial arch.

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Cross-arm Adduction Impingement Test
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Speeds Test

• A provocative test for biceps tendon pain in
  which the shoulder is flexed against resistance
  with the forearm supinated.

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Speeds Test
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Yergasons Test

• A provocative test for biceps tendon pain in
  which the patient is asked to simultaneously flex
  the elbow and supinate the forearm against
  resistance.

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Yergasons Test
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Knee Tests

• Apleys Test
• McMurry Test
• Anterior Drawer Sign
• Lachmans Test
• Posterior Drawer Sign
• Posterior Sag Sign

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Apleys Test

• A provocative test to elicit the pain associated
  with a meniscus tear by compression and rotating
  the knee in the 90 degrees flexed position.

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Apleys Test
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McMurray Test

• A provocative test to elicit pain and clicking
  associated with a torn meniscus by passively
  manipulating a hyperflexed knee.

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McMurray Test
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Anterior Drawer Sign

• A manipulation test to detect abnormal anterior
  laxity of the knee in the 90 degrees flexed
  position primarily a test of anterior cruciate
  ligament (ACL) integrity.

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Anterior Drawer Sign
Anterior Drawer in sitting in position. Examiner
feels anterior shift
Examiner watches for anterior shift.
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Lachmans Test

• A manipulative test for detecting abnormal
  anterior laxity in the knee performed in a
  position of mild flexion primarily a test of
  anterior cruciate ligament (ACL) integrity.

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Lachmans Test
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Posterior Sag Sign

• With the knee flexed at 90 degrees, it causes the
  tibia to drop or sag back on the femur because of
  gravity, if the posterior cruciate ligament (PCL)
  is torn.

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Posterior Sag Sign
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Waddell Signs

• Hoover Test
• Straight leg raise (seated vs. supine)
• Non-Anatomic distribution of weakness/numbness
• Trunkal Rotation
• Occipital Compression
• Over reaction to light stimulus