Wrist

1
Wrist Hand Evaluation

• Part Three

2
Special Tests

• Compression test
• Flick/tap test
• Percussion test
• Collateral stress (wrist)
• Collateral stress (fingers)
• Watson Clunk
• Tinels sign
• Digital Allen test

• Phalen
• Reverse Phalen
• Murphys sign
• DeQuervains/Finkelstein
• Long Finger Flexion test
• Paper/Froment sign
• Bunnell-Littler test

3
Compression Test (fracture)

• Examiner begins by grasping pts 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

4
Flick/Tap Test (fracture)

• Stabilize pts finger with one hand and flick
  or tap the tip of pts finger with the index
  finger of the other hand
• Repeat on all digits
• Pain indicates a positive test for possible
  fracture

5
Percussion Test (fracture)

• Stabilize pts hand with one hand and percuss
  pts fingers independently with the index finger
  of the other hand
• Repeat on all digits
• Pain indicates a positive test for possible
  fracture

6
Collateral Stress Test (wrist) (capsular laxity)

• The examiner stabilizes the pts distal forearm
  with one hand while grasping the pts hand with
  the other
• While holding the pts forearm in a neutral
  position, the examiner then applies valgus and
  varus forces to the pts wrist to test the
  integrity of the pts medial and collateral wrist
  ligaments, respectively

7
Collateral Stress Test (fingers) (laxity)

• The examiner stabilizes the pts 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

8
Watson Clunk Test (instability)

• The examiner stabilizes pts distal radius and
  ulna with one hand and grasps the pts scaphoid
  bone with the thumb and index finger of the other
• The examiner then attempts to translate the pts
  scaphoid anteriorly and posteriorly
• Dislocation and/or subluxation indicates a
  positive test for scaphoid instability

9
Tinels Sign (at wrist) neuritis)

• Examiner taps lightly over the pts transverse
  carpal ligament, looking for signs of paresthesia
  along the distal-most distribution of the median
  nerve
• Note reflex hammer not required

10
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 pts radial artery and index finger over
  the pts ulnar artery
• If pts 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

11
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

12
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 athletes carpal tunnel
• Tingling, numbness, and/or paresthesia indicates
  a positive test for carpal tunnel syndrome

13
Murphys 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

14
DeQuervains (Finkelstein ) Test (DeQuervains
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)

15
Long Finger Flexion Test (tendon rupture)

• Independently isolate each of the pts
  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

16
Paper Test /Froments 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

17
Bunnel-Littler Test (hypomobility)

• Examiner holds the pts MCP joint in slight
  extension while 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 pts 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