1
Q
Active Range of Motion - Wrist and Hand
A
Wrist:
- Flexion (85-90)
- extension (70-90)
- ulnar deviation (30-45)
- radial deviation (15)
- pronation (90)
- supination (90)
Finger:
- Flexion (MCP 85-90, PIP 100-115, DIP 80-90)
- Extension (MCP 30-45, PIP 0, DIP 20)
- abduction (20-30) and adduction (0)
Thumb:
- Flexion (CMC 45-50, MCP 50-55, IP 85-90)
- Extension (MCP 0, IP 0-5)
- abduction (60-70) and adduction (30)
- opposition of the little finger and thumb
2
Q
Fanning and Folding of the Hand
(rotation of hand)
A
Purpose:
- assess the conjuction rotation of the hand
Procedure:
- examiner hold the scaphoid and trapezium with index and middle finger and pisiform and hamate with the other hand
- hold the capitate and trapezoid
- fold and fan the hand, feeling the movement while montioring and feeling for crepitus and joint motion
Positive:
- symptom reproduction or abnormal movement is a positive result
note:
- test is used as general screening examination
3
Q
Finkelstein Test
(EPB and APL tendons)
A
Purpose:
- assess irritationm of the extensor pollicis brevis and abductor pollicis longus tendon as they pass deep to the extensor retinaculum in the first dorsal compartment in the wrist
Procedure:
- pt makes a fist with the thumb inside the fingers
- stablize forearm and passive ulanr deviation
Positive:
- pain or reproduction of symptoms over the EPB and APLT, indicates paratendonitis or tendinosis
Note:
- compare both sides as pain can be discomforting normally
- only if pain on affected siode is greater
4
Q
Tinel’s Sign - Wrist
(median nerve)
A
Purpose:
- assess for median nerve involvement at the carpel tunnel of the wrist
Procedure:
- supinate the pt’s hand and wrist and stablizes the forearm with the secondary
- primary hand is used to tap along the median nerve pathway
- tap over the carpel tunnel at the wrist with the index and muddle finger, working up the arm and following the path of the median nerve
Indication:
- postive test is indicated by tingling or paraesthesia into the thumb, index finger (forefinger) and the middle and lateral half of the ring finger (median nerve distribution)
- may feel numb distal to tapping
Note:
- test indicates the rate of renegeration of sensory fibres of the median nerve
- distal point at where normal sensation is felt represtns the limit o nerve regenration
- can be applied at many entrapment sites
5
Q
Phalen’s (wrist flexion) Test
(median nerve)
A
Purpose:
- assess for median nerve involvement through carpel tunnel of the wrist
Procedure:
- pt is sitting or standing and flexes the wrist maximally and pushes the dorsum of the hands together
- hold for 1 minute
Indication:
- tingling in the thumb, index, middle and lateral half of the ring finger
- carpel tunnel syndrome caused by pressure (compression) in the carpal tunnel
Note:
neuro dysfunction are suggestive of a nerve lesion but not all the time, best way to conclude is with electrodiagnostic
6
Q
Reverse Phalen’s Test
(median nerve)
A
Purpose:
- assess for median nerve involvement at carpel tunnel of the wrist
Procedure:
- pt is sitting or standing
- asked to place their palms together towards waist while keeping the palms in full contact, causing extension of the wrist
- hold for one minute
indication:
- positive test result is indicated by tingling in the thumb, index, middle, lateral half of the ring finger
- indicates carpal tunnel sybdrome caused by stretching the median nerve
7
Q
Carpal Compression Test
(median nerve and ulnar nerve)
A
Purpose:
- Part 1 - pressure provocation test over the carpal tunnel assess median nerve
- Part 2 - pressure provocation test over the tunnel of guyon to asses ulnar nerve
Procedure:
- Part 1 - apply direct thumb pressure over the carpal up to 30 seconds
- Part 2 - apply direct thumb pressure over the tunnel of guyon for up to 30 seconds
indication
- reproduction of symptoms, combned with releift when pressure is released
- numbness around nerve distribution
8
Q
Allen Test
(ulnar and radial artery)
A
Purpose:
- assess the patency of the ulnar and radial arteries and to determine which artery is providing the main blood supply to the hand
Procedure:
- asked ot open and close hands quicky and then squeeze hand tight to force blood out
- thumbs are placed over the radial and ulnar arteies and pressed
- asked to open hand
- open one thumb while keeping pressure on the other
- repeat
Indicates:
- normal - hand should flush with release of one
- slow flush mayb indicate a partial or full block
Notes:
- Test both ahnds
- can be done in abduction to maximise block
9
Q
Digital Blood Flow (perfusion) Test
A
Purpose:
- determine patency of digital arteries in the fingers
Procedure:
- comrpess nail bed and release, note for time it takes for colour to return
- compare both sides
indication:
- colour should return to the nail bed 3 secs
- if takes longer it can mean arterial insufficicy
10
Q
Fovea Sign
(distal ulnar ligaments)
A
Purpose:
- provocation of disassociation of the distal radio-ulnar ligaments from the fovea region of the ulnar head or injury to the ulanr ligaments
- Ulnatriquetral lig
- ulnalunate lig
- ulnacapitate lig
- tfcc tear
procedure
- pt sits with elbow on table and arm is flexed to 90-100 and forearm is neutral
- push thumb inot soft spot between ulnar styloid and flexor carpi ulnaris tenson, volar surface of the ulna head and the pisiform
Postive:
- tenderness compared to the other side
- replication fo complaints
- grimacing
indicates:
- dysfucntion of the distal radio ulnar ligament or the ulnar carpal ligaments or the TFCC
11
Q
TFCC Load Test
A
Purpose:
- assess the integrity of the TFCC in the wrist
Procedure:
- stabiliser the pt’s wrist by contacting hand in a handshake position
- stablise elbow
- passive ulnar deviate and applies an axial load through pt’s wrist
- the wrist may also be rolled from flexion to extension while maintain ulnar deviation which is referred to as grinding or scouring
Positive:
- pain, clicking, crepitus in the area of the TFCC
indicates:
disruption of the TFCC
12
Q
Finger Extension (shuck) test
instability, inflammation and keinbocks disease
A
Purpose:
- General screening tool for wrist
- instablity
- inflammation
- keinbocks diease - lunate
Procedure:
- hold pronated wrist at 45 flexion
- examiner contacts the pt’s metacarpals and asks the pt to activrly extend the wrist and hand against resistance
Positive:
- pain
- instability
- inflammation
- keinbocks disease
13
Q
Watson (scaphoid shift) test
(scapholunate joint)
A
Purpose:
- assess rhe integrity and stability of scapholunate joint
- scapholunate lig tear, joint instability, joint subluxtion
Procedure:
- pt elbow on table witrh elbow flexed ands palm facing practitioner
- contact metacarpals with secondary and create ulnar deviation and slight wrist extension
- then contact scaphoid with primary using a pincher grip with thumb over the volar scaphoid
- a-p pressure to volar scaphoid with radial deviation and flexin over pt’s hand and thumb
Postive:
dorsal scaphoid shift on flexion and clunk on relase of thumb contact
scapholunate instablity
14
Q
Lunotriquetral Ballottement Test
(lunotriquentral joint)
A
Purpose
- assess the integrity and stability of the lunotriquetral joint
- sprain, instablity, subluxation
Procedure:
- grasp the triquetrium with the thumb and index finger of the primary and grasp lunate with thumb and index of secondary
- move the lunate P-A and A-P
postive:
- laxity, crepitus and pain
- instablity
- distal radio ulnar joint instability
15
Q
Dorsal Capitate Displacement Apprehension Test
(capitate bone)
A
Purpose:
- test stablity of the capitate bone
Procedure:
- hold distal forearm in neutral with secondary
- pincher grip over capitate (thumb on palm)
- push thumb posterily
Positive:
- reproduction of symptoms pain and apprehensin
- clicking
- instablity
*
16
Q
Thumb: Valgus/Varus Stress Test
(ulnar and radial collateral ligament)
A
Purpose:
- assess the integrity of the ulnar and radial ligaments of the MCP joint of the thumb
Procedure:
- part 1 -pincher grip the first Metacarpal joint with secondary
- hold 1st MCP joint in 0 extension and applies valgus stress with primary
- repeat test with 30 degree flexion
- part 2 -pincher grip the first Metacarpal joint with secondary
- hold 1st MCP joint in 0 extension and applies varus stress with primary
- repeat test with 30 degree flexion
Postive:
- laxity with or without pain
- empty end feel
indication:
- laxity greater than 30-35 = complete tear
- laxity less than 30-35 = partial tear
- testing in extenion test the joint capsule and collateral ligaments
- flexion localises the colatteral ligament
17
Q
Finger: Valgus/Varus Stress Test
(collateral ligaments of MP and IP joints)
A
Purpose:
- assess the ccollateral ligaments of the MCP and IP joints of fingers
- colatteral lig sprain and avulsion fracture
procedure:
- stablise finger proximal to joint with 2nd
- should be in flexion when assessing IP joint
- apply valgus force while joint is held in a fully extended position
- stablise finger proximal to joint with 2nd
- should be in flexion when assessing IP joint
- apply varus force while joint is held in a fully extended position
positive:
- laxity with or without pain
- empty end feel
indicates:
- collateral lig injury
- avulasion fracture
note:
- should perform in varying degrees of flexion to test different aspects
- test at 0 and 30
18
Q
Profundus Test
(flexor digitorum profundus)
A
Purpose
- disassociation of flexor digitorium profundus from distal phalax
Procedure:
- holds affected finger in extension
- all other fingers are held in extension
- asked to flex only the DIP joint of afffected finger
Positive:
- inability to flex the affected DIP joint
Indicates:
- rupture of the flexor digitorum profundus
19
Q
Sweater Finger Sign
(flexor digitorum profundus)
A
Purpose:
- assess the disassiciation of the flexor digitorum profundus from distal phalax
Procedure:
- ask patient o make a fist
- observe for inablity to flex affected finger into a fist shape
Postive:
- inability of the patient to flex the distal interphalangeal joint
Indicates:
- rupture of the flexor digitorum profundus tendon fromt he distal phalax
20
Q
Superficialis Test
(flexor digitorum superficialis)
A
Purpose:
- assess disassociatipn of the flexor digitorium superficialis from middle phalax
Procedure:
- hold pt’s unaffected fingers in extension
- ask pt to flex the affected finger
Postive:
- inablity to flex the affected PIP joint
Indication:
- rupture of the flexor digitorum superficialis
21
Q
test for extensor hood rupture
(extensor hood)
A
purpose:
- test integrity of the extensor hood
procedure:
- pt is sitting with pronated forearm sitting over a an edge of a book or examinting surface.
- PIP jopint is flexed over the edge
- apply pressure and ask patient to extend against resistance
Postive:
- unable to feel extension
- distal phalax may extend as pt tries to extend at PIP joint
Indication:
- complete rupture of the central slip of the extensor mechanism
Note:
- boutonieere deformity
*
22
Q
Bunnel-Littler Test
A
Purpose:
- assess for potential causes of limited PIP joint flexion
- can be used to examine swan neck deformity
Procedure:
- affected MCP joint is held in extension
- passive flexion of the PIP joint
- if cannot flex then flex the MCP joint then reattempt the PIP flexion
- pt to remain passive
Postive:
- inability to flex PIP with extended MCP joint indicates contracture of the PIP joint or tight muscles
- Inablity to flex the PIP with flex MCP indicates PIP joint contracture
23
Q
Test for Trigger Finger
(nodules and thick regions of flexor tendons)
A
Purpose:
- assess the noduiles or thickening of regions of the flexor tendons in the hand
Procedure:
- grasp the affected finger with pincher gripwith index finger or thumb over location of the proximal pulley
- ask pt to flex the finger over contact
Positive:
- examiner may feel small nodule pass underneath thri fingers and complaing of pain
Indication:
- stenosing tenosynovitis (trigger finger)
- early stage dupuytren’s contracture
Orthopaedic Testing
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Decks in class (8)
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