Wrist and hand special test

Threshold for discrimination

Move proximal to distal to find the minimal distance the patient can distinguish between two stimuli

Score for 2 point

Pt must get 7/10 correct to move to a smaller gauge

Normal discrimination distance

<6mm

Fair discrimination distance

6-10 mm

Poor discrimination distance

11-15mm

Protective sensation

1 point perceived

Anesthetic sensation

0 points perceived

sewing requires

6-8mm

winding a watch requires

6mm

Handling precision tools requires

12mm

Gross tool handling requires

15mm

Wrist ligamentous tests

• Piano Keys Test

• Lichtman Test

• Press Test/ Sitting Hands

• Supination Lift Test

• Wrist flexion - Finger extension ("shuck") test

• Watson's scaphoid shift test

wrist musculotendinous test

• Finkelstein's Test

wrist nerve tests

• Tinel's Sign at the wrist (carpal tunnel, median)

• Flick sign/maneuver (carpal tunnel, median)

• Wrist ratio index (carpal tunnel, median)

• Phalen's test (carpal tunnel, median)

• Reverse Phalen's test (carpal tunnel, median)

• Wrist flexion & median nerve compression test/Carpal Compression Test - (carpal tunnel,median)

• Wartenberg's Test (superficial radial)

wrist circulation test

• Allen's test at wrist

Hand ligamentous test

• Varus/Valgus IP stress test (finger IP's)

• Thumb UCL stress test (game keeper's)

• Haines-Zancolli Retinacular test

• Bunnel-Littler test

Hand musculotendinous test

Elson's/central slip test

hand intra-articular test

Thumb CMC grind test

hand nerve test

froment's sign

Hand circulation test

Cap refill

Piano Keys test

Instability of the distal radioulnar joint, TFCC tear or triquetral instability

+ piano keys test

pain, excessive movement anteriorly or if the ulna springs back dorsally

Lichtman test

Midcarpal instability

+ lichtman test

midcarpal row jumps or snaps from an anterior subluxed position to the height of the proximal row

Seated press test

Assesses TFCC Tear; + test= pain in ulnar side of wrist or resistance to test

Supination Lift test

Assesses for TFCC Tear; + test is pain on ulnar side wrist w/ difficulty pressing up

Wrist flexion-finger extension/shuck test

Test assesses for Keinboch's, carpal instability, joint degeneration, synovitis; + test is pain over dorsal carpals or SL joint

VISI

Shuck test

also called Finger Extension Test

___Hold the pt's wrist in a flexed position with fingers extended (make sure your hand in on the dorsum of their wrist holding it into flexion)

___Apply pressure to extended fingers & ask patient to resist the motion

___Bilaterally performed

___Positive finding: pain in the wrist

___Indicates: radiocarpal, midcarpal or scaphoid instability, inflammation or Kienbock's disease

Watson's scaphoid shift test

Assesses dynamic stability and integrity of SL ligament

DISI

scaphoid shift test

pt is seated w/ elbow in 90º flexion+ slight pronation+ UD+wrist extension. →Clinician grasps and stabilizes scaphoid tubercle and grasps the metacarpals w/ other hand→move wrist into flexion+RD→UD +extension

+ scaphoid shift test

pain at posterior dorsal wrist or clunk of the scaphoid

Finkelstein's test

Assess tenosynovitis of APL and EBP (DeQuervain's); + test is reproduction of symptoms

Tinel's @ carpal tunnel

Assesses for CTS; + test is tingling or paresthesia down median distribution

Flick sign/maneuver

+ test indicates CTS by resolving paresthesia symptoms during or after flicking the wrist

Wrist ratio index

Assesses for CTS; + test is ratio >0.67

Phalen's test

Assesses median nerve for CTS; + test: paresthesia down median n distribution

Reverse Phalen's Test

TESTING: Carpal tunnel syndrome

POSITION: Prayer position with palms together and fingers pointed upward

(+) TEST: If symptoms worsen

Carpal compression test

Assesses for median nerve compressions; + test for CTS is reproduction of symptoms along median nerve within 30 s

Wartenburg syndrome test

Assess for Superficial radial nerve palsy; + test: tenderness and paresthesia

Allen's test

Assesses the patency of wrist vessels; Normal filling time is <5s

Varus/valgus IP stress tests

Test: apply a varus/valgus force at the DIPs and PIPs

+ test is pain at collateral ligament or excessive motion

Thumb UCL Stress test

Assesses Gamekeeper's thumb/ UCL ligament; + test is pain at UCL or valgus movement is >30-35º

Haines-Zancolli retinacular test

Assesses if restricted flexion at DIP is d/t DIP restriction or tightness of the oblique retinacular ligament

Bunnel-Littler test

Assesses if PIP flexion is restricted d/t intrinsic muscle tightness or PIP capsular restriction

Elson's Central slip test

Assesses rupture of central slip; +test: absence of extension force at PIP and fixed extension at DIP

Thumb CMC grind test

Assesses integrity of the thumb CMC possible joint arthrosis and synovitis; + test reproduction of pain and crepitus at thumb CMC

Froment's sign

Assess weak AP and short head FPB indicates ulnar entrapment; + test is flexion at thumb IP d/t overeliance on FPL

Digital blood flow/capillary refill test

<2s normal

AAOS CTS

3-4 weeks

Wrist extension stretch/wrist flexion stretches

5reps 4x/day, 5-7d/week

Median nerve glides

10-15 reps, 6-7d/week

Tendon glides

5-10 reps, 2/3x day

Wrist general mobility

Grasp row of carpals and interlock fingers

Apply distraction in figure 8 or circumduction motion

Wrist CT MFR

Grasp thenar and hypothenar eminences at level of carpal tunnel→spread palm apart→engage restrictive barrier w/ light force→palpate for softening or release of restriction→hold for 3-5 mins