Practical 2_Special Tests

Question 1

1. Have your patient’s affected extremity extended so that the wrist remains at the edge of the treatment table with the arm in neutral rested in the table and hand hanging off.
2. Patient’s pain is then evaluated with gravity assisted ulnar deviation at the wrist.

Test is positive if patient reports pain at the tip of the styloid process.

Answer 1

Finklestein (Wrist)

De Quervain’s Tenosynovitis

Question 2

1. With patient’s arm relaxed in supine on treatment table, use 2 fingers to tap median nerve at wrist.

Test is positive it tingling is felt along the index finger, middle finger, and/or lateral half of ring finger are reproduced.

Answer 2

Tinel’s (Wrist)

Carpal Tunnel Syndrome

Question 3

1. In standing position, ask patient to flex their wrists maximally and hold the dorsal side of his hands together for 1 minute.

Test is positive it tingling is felt along the index finger, middle finger, and/or lateral half of ring finger are reproduced.

Answer 3

Phalen’s (Wrist)

Carpal Tunnel Syndrome

Question 4

1. Ask patient to bring hands together in a 90 degree/prayer position for 1 minute.

Test is positive if numbness, tingling or pain is felt.

Answer 4

Reverse Phalen’s (Wrist)

Question 5

1. Ask patient to open and close the hand several times as quickly as possible and then squeeze the hand tightly
2. Then compress the radial and the ulnar arteries with your thumbs.
3. Hold it quickly and then ask your patient to open the hand and release the radial artery and you can see how the blood is streaming back into the hand quickly.

Complete the same process on Ulnar Artery
1. Ask patient to open and close the hand several times as quickly as possible and then squeeze the hand tightly
2. Then compress the radial and the ulnar arteries with your thumbs.
3. Hold it quickly and then ask your patient to open the hand and release the ulnar artery and you can see how the blood is streaming back into the hand quickly.

A healthy artery, the blood should stream back into the hand quickly (red color).

Answer 5

Allen’s (Hand)

Hand Vascularisation

Question 6

1. Patient sitting with elbow supported on the treatment bench and facing the examiner.
2. Fixate your patient’s radius with one hand and give pressure on the palmar prominence of the scaphoid with your thumb into dorsal direction.
3. With the other hand grasp the patient’s metacarpals from the ulnar side to control the wrist.
4. Start and ulnar deviation and slight extension.
5. Then move the wrist into radial deviation and slight flexion while keeping pressure on the scaphoid.
6. Release thumb and the scaphoid often shifts back in palmar direction with a “thunk.”

Test is positive if a “thunk” can be felt or heard or if pain is felt on the dorsal side.

Answer 6

Watson Test (Wrist)

Scapholunate Instability / SI ligament rupture

Question 7

1. After stabilizing the thumb at the 1st metacarpal, a valgus stress is applied to the thumb at the MCP joint.

Laxity indicates a partial or complete ulnar collateral ligament tear.

Answer 7

Thumb Ligament Test (Finger)

Thumb Ulnar Collateral Ligament Stress Test

Question 8

1. Patient in sitting position with hand and forearm placed on the treatment table in prone position.
2. Grab the lunate bone with one thumb and the triquetrum with the other thumb.
3. Fixate the lunate and do a dorsal palmar glide of the triquetrum.

A positive test is indicated by noticeable laxity compared to the unaffected hand, as well as pain.

Answer 8

Shuck Test (Wrist)

Wrist Ligament Instability

Question 9

1. Patient sitting at treatment table with hands on the table.
2. Ask patient to make a fist in both hands.
3. Compare the dorsal knuckles - normally the second knuckle projects further distally than the other three.

A positive test indicates the second knuckle is at the same level as the first and third knuckle.

Answer 9

Murphy’s Sign (Hand)

Lunate Dislocation

Question 10

1. Patient in side lying position at the edge of the table.
2. Bring patient’s upper leg to 60 degrees of hip flexion with a flexed knee and the lower leg completely extended.
3. With the upper hand fixate the pelvis and then apply downward pressure on the knee.

Test is positive if patient is complaining about pain in the buttock area or radiating pain down the backside of the leg.

Answer 10

Piriformis Test (Backside)

Piriformis syndrome or tightness

Question 11

1. Have patient stand in front of wall on one leg.
2. Pelvis on the opposite side should rise a little higher.

Test is positive if the pelvis on the opposite side drops.

Answer 11

Tredelenburg Test (Hip)

Hip Abductor Weakness

Question 12

1. Patient in supine position.
2. Bring your patient’s hip to 45 degrees and knee into 90 degrees of flexion.
3. Sit on patient’s foot to stabilize and palpate the joint line with thumbs.
4. Try to move the tibia anteriorly in an explosive movement.

Test is positive if tibia translates anteriorly more than 6 millimeters or if you experience a soft and mushy end feel.

Answer 12

Knee Anterior Drawer Test (Knee)

ACL Rupture/Tear