Exam 3- Orthopedic Test of the Elbow, Wrist and Hand

Elbow flexion test

Seated

Flexes elbow, asymptomatic first

Held in flexion for 5 minutes or until symptoms occur

Elbow flexion test tests for?

Cubical tunnel syndrome

How does cubical tunnel syndrome occur during the elbow flexion test

Position causes stress to the ulnar nerve at the cubical tunnel

______________during the elbow flexion test in less than 5 minutes suggest cubital tunnel syndrome

Ulnar parenthesia

Tingling or parestheisa in the ulnar distribution of the forearm and hand during the elbow flexion test suggests?

Cubital tunnel syndrome

Tinel`s sign at the elbow

Tap with reflex hammer 1 inch above and 1 inch below the olecranon process and lateral epicondyle on asymptotic side first

During tinel`s sign at the elbow, hypersensitivity indicates?

Neuritis or neuroma of the respective nerve

Hypersensitivity at the medial epicondylar groove during tinel`s sign at the elbow suggests?

Ulnar neuropathy

Hypersensitivity at the lateral epicondylar groove during tinel`s sign at the elbow suggest

Radial neuropathy

Cozen`s test

Seated, forearm over thigh, clenches fist tightly and extends wrist, maintaining a pronated position

Examiner stabilizes forearm and applies resistance to patients extended wrist

(Same as muscle testing wrist extension)

Positive Cozens test is

Pain over the lateral epicondyle

Positive Cozens test indicates

Lateral epicondyle irritation

When Cozens test is positive is it significant for/

Epicondylitis or radiohumeral bursitis

Golfers elbow test

Seated, forearm on thigh

Clenches fist, flexes wrist and maintains supination position

Patient flexes wrist and elbow against resistance

Pain?

Positive golfers elbow test

Pain over medial epicondyle

Positive golfers elbow test indicates

Medial epicondylitis

A positive golfers elbow test is common in who?

Kids from baseball

Lift test is good for?

Quantifying how bad the irrigation is by using weights

Lift test

Seated, forearm on thigh

Clenches sandbag or barbell tightly, extends wrist, maintains pronated position

Do it again but flexing instead while supinated

Positive lift test when doing extension

Pain over lateral epicondyle

Positive lift test when doing extension indicates

Lateral epicondylitis

Positive lift test when doing flexion

Pain over medial epicondyle

Positive lift test when doing flexion indicates

Medial epicondylitis

Ligamentous instability test

Seated with elbow slight flexed

Test abduction and abduction of the elbow joint

Adduction during the ligamentous instability test tests

Lateral collateral ligament

Abduction during the ligamentous instability test tests

Medial collateral ligament

Mill`s test

Seated, examiner passively flexes elbow then flexes patients wrist and fingers then supinates the forearm

Maintains the wrist and finger flexion and supination, extend the patients elbow

Then extends the elbow to maximum extension with wrist and fingers still flexed, forearm is pronated

Pain, point to it

All the moves of Mill`s test should be?

Smooth and continuous manner

Positive Mill`s test

Elbow pain increases

Positive Mill`s test indicates

Lateral epicondylitis (tennis elbow)

What is the gold standard for testing for carpal tunnel syndrome

Tinels sign at the wrist

Tinels sign at the wrist

Seated, elbow flexed and forearm supinated

Slight dorsiflex the patients wrist and hand

Hit with the reflex hammer on the wrist over the carpal tunnel

What is the median nerve distribution

Thumb, index finger, middle finger, lateral half of ring finger

Positive Tinels sign at the wrist

Tingling/pain felt along the median nerve distribution distal or below to the pint of percussion

Positive Tinels sign at the wrist when distal to the point of percussion indicates

Regeneration of the nerve

CARPAL TUNNEL SYNDROME

Positive Tinels sign at the wrist when below the point of percussion indicates

Neural inflammation and generation

CARPAL TUNNEL SYNDROME

What is the 2nd best test for Carpal Tunnel Syndrome

Phalens test

Phalen`s test Part 1

Seated with both elbows flexed and arms pronated

Wrist are flex, and the dorsal surface of the hands are approximated together

Hold for 60 seconds

Phalens test part 1 looks for?

Neural ischemia of the median nerve

Phalens test part 2 is also called

Reverse Phalens

Phalens test part 2 (Reverse Phalens)

Seated with both elbows flexes and arms pronated

Wrist are extended and the palms of the hands are approximated to each other

Hold for 60 seconds

Phalens test part 2 (reverse Phalens) looks for

Neural stretch and compression of the median nerve

Froments test

Seated

Adducts thump to the tip of the index finger

Place paper between the fingers and resist allowing the paper to be pulled form the grip of the index finger and thumb

Positive froments test

When paper is pulled and see the terminal phalanx of the thumb go into flexion to add support

Positive froments test indicates

Paralysis of the adductor polices muscle and suggest ulnar nerve injury-palsy

Pinch grip test

Seated

Pinches tips of index finger to the tip of the thumb

Paper between, resist allowing the paper to be pulled out

Positive pinch grip test indicates

Weakness of the anterior interosseous nerve

Positive pinch grip test

When pulling the paper out you see the terminal phalanx of the thumb go into the pulp of the finger to a pulp of the thumb grip

Bunnell-Littler test

Seated, elbow flexed, forearm pronated and wrist extended

Examiner slightly extends MCP of the digit under examination

Then flexes PIP and DIP joints

During the Bunnell-Littler test if the joint under examination cannot be passively flexed then this suggests?

Tight intrinsic musculature or contracture of the joint capsule

Pain and or joint contracture of the PIP and DIP during the bunnell-littler test suggest

Osteoarthritis

Finkelstein`s Test

Seated, makes a fist with thumb inside fingers

Examiner passively decimates wrist in ulnar direction

Pain, point to i

Positive Finkelstein`s test

Pain over abductor policy's longus and extensor pollicis brevis tendons

Positive finkelsteins test indicates

Stenosing tenosynovitis in the tendons of the abductor pollicus longus and extensor pollicus brevis tendons

Mannkopf`s sign

Establishes patients resting heart rate

Applies mechanical pressure or electrical stimulation over painful area while monitoring pulse

Positive Mannkopf`s sign

Increase in pulse rate of 10 or more BPM

Positive mannkopfs sign indicates

Pain is organic

Sign would be absent in simulated pain

Sometimes you can have a negative Mannkopf`s but still have true pain because the patients pain tolerance is high.... How can you confirm this?

Littmanns test