wrist joint special tests

SPECIAL TESTS FOR  WRIST  JOINT :-

TESTS:-

1) TESTS FOR  NERVE INVOLVEMENT  :- 

MEDIAN NERVE  TEST:-

 -Perform for  carpal tunnel  syndrome. 

A) Phelen's test :-

-The examiner or  patient  himself  flexes the  wrist maximally  and hold the position  atleast  for  one  minute  by pushing  the  wrist  together  .

-A positive  test  indicated  by  tingling  in  thumb  ,  index  finger  and  middle  and  lateral  half  of  ring  finger  .

-positive  test  indicates  carpal tunnel  syndrome. 

B) Revers  phalen's or  prayer   test:-

-The  examiner  extends the  patient 's wrist  while  asking him to grip the  examiner  's hand .

                           The  examiner  applies  direct pressure  overe the carpal  tunnel  for  1 minute.

- This test patient  himself  can perform  by maKing the  prayer  position  of hands.

-The  test produces  same symptoms  asuch Phelen's  test.

C)Tinel 's sign test:-

-The  examiner taps  over  the  carpal  tunnel  at wrist  . 

-A positive  test  causes  tingling  or  paraesthesia  into  thumb  ,  index  finger  and  middle  and  lateral  half  of  ring  finger  .

-Positive  test  indicates  carpal tunnel  syndrome. 

ULNAR  NERVE  TEST:-

A)Fromet's  "Paper"sign :-

-Ask the  patient  to  grasp  the  piece  of  paper  between  thumb  and  index  finger  while  the  examiner  attempts  to  pull  away  the  paper  . 

-If the  terminal  phalanx  flex due to  paralysis  of  adductor  pollicis  musclear  .

-Indicates  positive  test  for  Ulnar  nerve  involvementioned. 

SPECIAL TESTS  FOR CIRCULATION:-

A) Allen's  test:-

-The  patient  is asked  to  open  and  close the  hand  several  times  as quickly  as  possible  and then  squeeze  the  hand tightly. 

-The examiner  compresses the radial and ulnar  arteries  with the help of  thumb and index  finger  .

-Ask the  patient  to  open  hand while pressure  is maintained  over the  arteries. 

-Release  the  pressure  overe the arteries  one by one  and see if the  hand  flushes.

This  test the  potency of Radial and  ulnar arteries  . 

TESTS FOR LIGAMENT  RUPTURE :-

A)Finkelstein test :-

-Ask the  patient  to  make   a fist with   thumb  inside  the  fingers. 

-The examiner  stabilises  the  patient 's forearm  and  deviates  the  wrist  towards  ulnar  side  .

-A positive  test   indicated by  pain   over abductor  pollicis  longus  and  the extensor  pollicis  brevis  tendons  at  wrist. 

-Positive  test  indicates  De-quervain  Tenosynovitis. 

B) Bunnel  Littler  Test :-

-For  tight  intrinsic  muscles  or  contracture  of  the  joint  capsules  .

-The MCL joint is held  in  slightly  extended while  the  examiner  attempts   to move  the proximal  interphalangeal  joint. 

-Inability  to  flex  the  proximal  interphalangeal  joint  indicates  tightness of  intrinsic  muscles  or  contracture  of  the  joint  capsules  .

Other  tests  :-

1)Long finger  flexor  test  

2) Varus  test  for  Radial  collateral  ligament laxity. 

3)Valgus  test  for  Ulnar  collateral  ligament  laxity. 

TESTS  FOR  BONE  FRACTURE :-

A) Axial  compression or  load  test:-

-The  patient  sits  comfortably  while examiner  stabilises  the  patient  's wrist  with  one hand  .

-With other hand examiner  grasps  the  patient 's thumb  and applies  Axial  compression. 

-Pain and  crepitus  indicates  positive  test  for  Metacarpal or adjacent  carpal  bones  fracture. 

This may also apply  for fingers. 

Tap or percussion  test  :-

-Patient  sits  in comfortable  position  with  hand  rest on chair  arm.

-The examiner gently percusses the each  finger.

-Pain and crepitus  indicates  bony Fracture. 

Test for Lunate  Dislocation:-

1)Murphy 's sign  test  :-

-Asked  the patient  to  make  a  fist .

-See the level  of  third metacarpal  with  second  and fourth metacarpals.

-If the head of third  metacarpal  is in the  level  of  second and fourth metacarpal  it shows  Lunate dislocation .