hand special tests

Question 1

Finkelstein

Answer 1

purpose: DeQuervain’s syndrome (inflammation of the extensor polices brevis and abductor pollicus)

pt. pos: sitting or standing

prac. pos.: standing next to pt.

procedure: have the pt. make a fist holding the thumb and passively move into ulnar deviation

positive: pain over the dorsal surface of the thumb

Question 2

tinel’s

Answer 2

purpose: median nerve pathology (carpal tunnel syndrome)

pt. pos: standing or sitting

prac. pos.: facing pt.

procedure: nerve is tapped with the tip of one finger, in this instance, on the medial nerve distribution on the anterior wrist at the retinaculum

positive: shooting pain along the distribution of the median nerve

Question 3

phalan’s

Answer 3

purpose: carpal tunnel syndrome presence

pt. pos: sitting or standing

prac. pos.: standing next to pt.

procedure: pt is instructed to push the dorsal aspects of both hands together, with the fingers pointing downward and hold the position for 1 minute

positive: numbness or tingling along the median nerve distribution; the solar aspect of the thumb and 2 1/2 fingers

Question 4

carpal compression

Answer 4

purpose: carpal tunnel syndrome presence

pt. pos: sitting or standing

prac. pos.: standing in front of pt.

procedure: entire length of a finger or the thumb is placed on the volar aspect of the wrist, at the retinaculum and compressed

positive: tingling, pain or numbness along the median nerve distribution

Question 5

allen’s test for the wrist

Answer 5

purpose: to determine vascularity of the hand

pt. pos: sitting or standing, palm supinated

prac. pos: standing in front of pt. one thumb on the radial artery and one on the ulnar artery on the volar aspect of the wrist

procedure: thumbs are compressed over both arteries and the pt. is instructed to compress and relax the hand several times until the hand turns white. one finger (done twice) is released and the hand should return to it’s normal pink color

positive: slow return of blood flow or the hand staying white

Question 6

varus/ valgus

Answer 6

purpose: ligamentous instability, particularly collateral ligaments

pt. pos: standing or sitting

prac. pos: standing in front of pt.

procedure: distal finger is stabilized and the valgus or varus force is applied through the joint line and an anterior r and posterior glide is applied

positive: instability with any movements

Question 7

gamekeeper’s test

Answer 7

purpose: ulnar collateral ligament of the thumb

pt. pos: standing or sitting

prac. pos: standing in front of pt.. one hand stabilizing the metacarpal of the thumb, the other hand grasping the distal thumb

procedure: valgus force is applied

positive: excessive moment of the joint or pain

Question 8

tap

Answer 8

purpose: determine presence of a fracture of a phalanx or metacarpal

pt. pos: standing or sitting

prac. pos: standing in front of pt.

procedure: light tap with the pad of one finger is applied through the long axis of the phalanx or metacarpal. the finger can be flexed at the PIP or MP joints and tapped there for proximal segments

positive: pain long the shaft of the bone

Question 9

Murphy’s sign

Answer 9

purpose: dislocation of the lunate carpal bone

pt. pos: standin or sitting with hand in fist.

prac. pos: standing in front of pt.

procedure: pt is instructed to make a fist. observe 3rd MCP joint (knuckle)

positive: 3rd MCP joint will be lower or equal level to all the other joints (knuckles)