Elbow, Wrist and Hand Special Tests

Question 1

Tinel Sign

Answer 1

Sp. 0.99

Question 2

Elbow Flexion Test

Answer 2

Sp. 0.99

Question 3

Moving Valgus Stress Test

Answer 3

Backside of patient. Just shy of 90 abduction. Fully flex elbow. Apply valgus force while extending the elbow. Positive if painful arc between 120 to 70 flexion.

Sn 1.0

Question 4

Anterior Band Valgus Test

Question 5

Milking maneuver

Question 6

BCI

Answer 6

+ is greater than 6 cm. If injured side over uninjured side is greater than 1.2. Rupture.

Question 7

Passive Forearm Pronation

Question 8

Hook Test

Question 9

Mill’s Test

Question 10

Maudsley’s Test

Question 11

Cozen’s Test

Question 12

Radiohumeral Anterior Glide

Answer 12

Patient supine; distal humerus stabilized, anterior glide of radius.

Question 13

Radiohumeral Posterior Glide

Answer 13

Patient supine; distal humerus stabilized, Posterior glide of radius.

Question 14

Humeroulnar distraction

Question 15

If you suspect lateral epicondylalgia, what tests can you perform?

Answer 15

Cozen’s
Maudsley’s
Mill’s

Question 16

If you suspect Biceps involvement what tests can you perform?

Answer 16

Hook test
Passive pronation
BCI

Question 17

If you suspect MCL involvement, what tests can you perform?

Answer 17

Anterior band stress test: 20-30 flexion, valgus force applied while palpating MCL.

Milking maneuver: Over 55 flexion; thumb pulled into ER.

Moving valgus stress test (Sn 1.0): Behind patient. Arm abducted just shy of 90. Full flexion. Extend with valgus force. Pain 120-70 is positive for partial tear of MCL

Question 18

If you suspect an ulnar nerve pathology, what test can you perform?

Answer 18

Elbow flexion test (Sp 0.99)- tingling/paresthesia in ulnar distribution is positive. 30-60 second hold.

ULNT3

Tinel Sign (Sp 0.99) - Tingling in ulnar distribution when tapped.

Question 19

List the carpal bones in consecutive/bordering order.

Answer 19

Scaphoid, trapezium, trapezoid, capitate, hamate, triquetrum pisiform, lunate

Question 20

Finkelstein’s Test

Answer 20

Wrap thumb and go into ulnar deviation. Positive is pain along radial side of wrist/forearm.

Tests for tenosynovitis (tendon)

Question 21

Phalen’s Test

Answer 21

Maximum wrist flexion hold over 60s
Positive is tingling in median nerve distribution
Does reverse Phalen’s alleviate?
Sp varies, but one source gave 0.89.

Tests CTS

Question 22

Flick Test

Answer 22

Ask patient how they get rid of symptoms when they come on. If wrist flick, positive.
Sp: 0.92

“tests” CTS

Question 23

Watson’s test

Answer 23

Thumb on scaphoid. Patient ulnar deviates. Pressure applied on dorsum of wrist. Patient radially deviates. Positive if pain is felt

Indicates ligamentous instability between scaphoid and lunate.

Question 24

Figure 8 Test

Answer 24

Tests for swelling/effusion/edema

Question 25

Median nerve Tinels

Answer 25

Tests CTS

Question 26

Median nerve compression test

Answer 26

Thumb by thumb over the CT. Pressure for 30s. Numbness onset is positive. Sn 0.87 Sp 0.90 Tests CTS

Question 27

Ulnocarpal stress test

Answer 27

90 degree elbow and shoulder flexion Ulnar deviation Pronate and supinate while applying longitudinal pressure Reproduction of symptoms (clicking) is positive Tests instability of TFCC

Question 28

If you suspect CTS, what tests can you perform?

Answer 28

Phalens/reverse ask about flick test Median nerve compression test Median nerve Tinels

Question 29

If you suspect tenosynovitis what test can you perform?

Answer 29

Finkelstein's

Question 30

If you suspect ligamentous instability of the wrist, what test can you perform?

Answer 30

Watson's

Question 31

If you suspect instability of the TFCC what test can you perform?

Answer 31

Ulnocarpal stress test

Question 32

If you suspect radial nerve pathology what tests can you perform?

Answer 32

ULNT2 Tinels probably

Question 33

If you suspect median nerve pathology what tests can you perform?

Answer 33

All CTS tests I would think, especially Tinel's ULNT1

Question 34

ULNT1

Answer 34

Do active motion first Active: Standing, arm at side, elbow 90 flexion. Straighten elbow Bring arm out to side, above shoulder height Palm up, bend wrist and fingers back Tip head away Passive: Supine add gentle shoulder depression Abduct to 110 Extend wrist and fingies (approximate 1-3 with your own) Supinate forearm Shoulder ER Elbow extension Cervical lateral flexion away

Question 35

ULNT2

Answer 35

Do active motion first: Active: Standing, arm at side Flex wrist Turn palm so can look at it over shoulder Push wrist toward floor Tip head away Passive: Supine, shoulder slight abduction, elbow flexed across chest Depress shoulder girdle Extend elbow IR entire UE Flex wrist

Question 36

ULNT3

Answer 36

Do active first Active: Sit or stand, arm at side, elbow flexed 90 Bring arm up and out as if holding a tray of drinks on palm ALTERNATE: Mask position Passive:Supine, shoulder slight abduction and flexion, elbow slight flexion Extend wrist and fingers, thumb between web space. Index on ring, Mid on mid. Pronate forearm Flex elbow ER shoulder Depress shoulder girdle Abduct shoulder