Hand Orthopedic Tests

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Hand Orthopedic Tests
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Anterior Aspect
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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.

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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.

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Thenar Eminence
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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
  Guyons tunnel or more proximally in the
  extremity can cause muscle atrophy.

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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.

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Hypothenar Eminence
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Posterior Aspect
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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.

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Extensor Tendon Palpation

• With the patients 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.

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Extensor Tendon Palpation

• Loss of continuity after trauma rupture of
  tendon
• Small cysts may develop between the 2nd and 3rd
  metacarpal bones.

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Extensor Tendons
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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.

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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 (Heberdens nodes) osteoarthritis.

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Palpation of Metacarpals and Phalanges
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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.

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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.

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Varus and Valgus Stress Test
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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.

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Thumb Ulnar Collateral Ligament Laxity Test
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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.

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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.

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Bunnel-Littler Test
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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.

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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.

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Profundus Test
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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.

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Flexor and Extensor Pollicis Longus Test
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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.

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Extensor Digitorum Communis Test