Você está na página 1de 17

Part Three

Special Tests
1. Compression test

9. Phalen

2. Flick/tap test

10. Reverse Phalen

3. Percussion test

11. Murphys sign

4. Collateral stress

12. DeQuervains/Finkelst

5.
6.
7.
8.

(wrist)
Collateral stress
(fingers)
Watson Clunk
Tinels sign
Digital Allen test

ein
13. Long Finger Flexion
test
14. Paper/Froment sign
15. Bunnell-Littler test

Compression Test
(fracture):
Examiner begins by grasping pts hand and
compressing each digit along the long axis
Complete on all digits
Pain indicates a positive test for possible
phalangeal fracture
Do not perform if an obvious deformity is
present

Flick/Tap Test
(fracture)
Stabilize pts finger with one hand and flick
or tap the tip of pts finger with the index
finger of the other hand
Repeat on all digits
Pain indicates a positive test for possible
fracture

Percussion Test
(fracture)
Stabilize pts hand with one hand and percuss
pts fingers independently with the index
finger of the other hand
Repeat on all digits
Pain indicates a positive test for possible
fracture

Collateral Stress Test


(wrist)
(capsular
laxity):

The examiner stabilizes the pts distal forearm


with one hand while grasping the pts hand
with the other
While holding the pts forearm in a neutral
position, the examiner then applies valgus
and varus forces to the pts wrist to test the
integrity of the pts medial and collateral wrist
ligaments, respectively

Collateral Stress Test


(fingers)
(laxity):

The examiner stabilizes the pts finger with


the thumb and index finger of one hand and
applies mild varus and valgus force to each of
the interphalangeal joints with the thumb and
index finger of the other hand, looking for
laxity or abnormal joint opening that may be
indicative of lateral and/or medial collateral
ligament sprain
Repeat on all phalangeal articulations of all
fingers

Watson Clunk Test


(instability):
The examiner stabilizes pts
distal radius and ulna with one
hand and grasps the pts
scaphoid bone with the thumb
and index finger of the other
The examiner then attempts
to translate the pts scaphoid
anteriorly and posteriorly
Dislocation and/or subluxation
indicates a positive test for
scaphoid instability

Tinels Sign (at wrist)


neuritis):
Examiner taps lightly over the
pts transverse carpal
ligament, looking for signs of
paresthesia along the distalmost distribution of the median
nerve
**Note: reflex hammer not
required**

Digital Allen Test


(arterial
compromise):
The examiner instructs pt. to
rapidly open and close the hand
15 times
As soon as the athlete finishes
the final repetition, the examiner
places his or her thumb over the
pts radial artery and index
finger over the pts ulnar artery
If pts hand remains cyanotic
until after the examiner removes
the pressure, then the test is
positive for poor, impaired,
and/or depressed perfusion
(circulation) through the distal
extremities

Phalen Test
(CTS/neurologic
Position the patient with the
dorsal aspect of both hands
impairment):
in full contact with both
wrists maximally flexed
Instruct the patient to hold
the position for 1 minute
Tingling or numbness
radiating into the fingers
(especially the palmar
surface) indicates a positive
test for median and/or
radial nerve impairment

Reverse Phalen Test


(carpal
tunnel
Instruct pt to perform a Phalen
test with the wrists positioned in
syndrome):
full extension and the palms in
full contact
Prayer hands
Pt is instructed to hold the
position for 1 minute while the
examiner applies direct pressure
over the athletes carpal tunnel
Tingling, numbness, and/or
paresthesia indicates a positive
test for carpal tunnel syndrome

Murphys Sign (lunate


dislocation):

Examiner instructs pt
to make a fist, then
assesses contour of
MCP joints
If third metacarpal is
level with second and
fourth metacarpals,
lunate dislocation is
suspected

DeQuervains
(Finkelstein
)
Test
Instruct pt to abduct the thumb so that it
rests in the palm of the hand
(DeQuervains
disease):

Pt is then instructed to wrap the fingers


over the thumb in order to make a fist
Examiner then stabilizes the wrist with
one hand and applies a varus force to
the wrist
Sharp pain on the lateral aspect of the
wrist indicates a positive test for
stenosing tenosynovitis to the abductor
pollicus longus and/or the extensor
pollicus brevis tendon sheath(s)

Long Finger Flexion Test


(tendon
rupture):

Independently isolate each of the pts


interphalangeal joints, looking for obvious
inability to flex which may be indicative of
muscular lesion and/or avulsion
An inability to flex the DIP of any digit
indicates a positive test for flexor digitorum
profundus lesion
An inability to flex the PIP of any digit
indicates a positive test for flexor digitorum
superficialis lesion

Paper Test /Froments


Sign
(neurologic
Pt is instructed to hold a
piece of paper between the
impairment):
1 and 2 digits by
st

nd

forcefully opposing those


digits
The examiner then attempts
to pull the paper out
An inability to hold the
contraction and/or a weak
contraction indicates a
positive test for ulnar nerve
impairment

Bunnel-Littler Test
(hypomobility):
Examiner holds the pts MCP joint in slight extension
while moving the PIP joint into flexion
If the PIP joint cannot be flexed, the test is positive for
tight intrinsic muscles or contracture of the joint capsule
The examiner then slightly flexes pts MCP joint while
moving the PIP into flexion again
If the PIP joint will flex, then the intrinsic muscles are
tight
If the PIP joint will not fully flex, then the joint capsule is
tight
Repeat on all digits