Purpose: UCL sprain or rupture at the wrist
How to perform:
Pt is sitting or standing with elbows flexed 90° and palm up
Examiner has 1 hand @ distal forearm and other hand @ metacarpals
A distraction is applied by the hand at the metacarpals
While the distraction occurs, a valgus force is applied to the wrist joint
(+): increased laxity &/or pain = Means: UCL sprain/rupture 2 wrist
(-): no increased laxity &/or pain = Means: no UCL sprain/rupture @ wrist
Purpose: RCL sprain or rupture at the wrist
How to perform:
Pt is sitting or standing with elbows flexed 90° and palm up
Examiner has 1 hand @ distal forearm and other hand @ metacarpals
A distraction is applied by the hand at the metacarpals
While the distraction occurs, a varus force is applied to the wrist joint
(+): increase laxity &/or pain = Means: RCL sprain/rupture @ wrist
(-): no increased laxity and/or pain = Means: RCL sprain/rupture @wrist
Purpose: UCL sprain or rupture at the thumb
How to perform:
Pt is sitting with hand on table
Examiner takes 1 hand to stabilize just below to the MCP joint thumb
Examiner takes other hand above the MCP joint extending the thumb
Examiner than applies a valgus force to thumb’s UCL at 0° and 30°
(+):
1. Increased laxity &/or pain @ 0°
2. Increased laxity &/of pain @ 30°
3. Increased laxity &/or pain @ both 0° and 30°
Means:
@ 0° = aUCL sprain/rupture @ thumb
@ 30° =- pUCL sprain/rupture @ thumb
Both = aUCL and pUCL sprain/rupture @thumb
(-): no increased laxity &/or pain @ 0°,30°, and /or both = Means: no aUCL, pUCL, or both sprain/rupture at thumb
Purpose: Ligamentous staiblity of the wrist and fingers
How to Perform:
Pt is sitting / standing with arms in anatomical position
Examiner than has 1 hand distal to tested site of either the wrist or a finger and a hand above the test site
A slight distraction is applied as a ant/post glide is done on test site
(+): increase in laxity or/& pain = Means: ligamentous injury of wrist or finger
(-): no increased laxity and/or pain = Means no ligamentous injury of wrist or finger
Purpose: Collateral ligament sprainor rupture at the fingers depending on force applied
How to perform:
Pt is sitting relaxed with hand on table and palm up
Examiner stabilizes tested finger with 1 hand proximal to tested joint and other hand distal to tested joint
Examiner’s hand that is distal to tested joint will apply a valgus/varus force to the joint
(+): increase in laxity and/or pain = Means: collateral ligament sprain/rupture of fingers depending on force applied (valgus = UCL, varus = RCL)
(-): no increased laxity and/or pain = Means no collateral ligament sprain/rupture at fingers
Purpose: Median N Compression/carpal tunnel syndrome
How to perform:
Pt is sitting or standing
Pt is instructed to flex wrists maximally
Pt will then bring the dorsal/backside of their hands to each other in the center of the pt’s body
Pt will hold this position for 1 minute
(+): reproduction of neurological s/s = Means: median n compression/carpal tunnel syndrome present
(-): no reproduction of neurological s/s = Means: no median n compression/carpal tunnel present
Purpose: Median N tension/capral tunnel syndrome
How to perform:
Pt is sitting or standing with palms against one another
When the pt’s palms are against, one another it should be in the center of the pt’s body
Pt will hold this position for 1 min
(+): reproduction of neurological s/s = Means: median n tension/carpal tunnel syndrome present
(-): no reproduction of neurological s/s = Means: no median n tension/carpal tunnel syndrome
Purpose: DeQuervain's Syndrome/Extensor pollicis tenosynovitis
How to perform:
Pt is sitting with elbow @ 90° and thumb up
Pt is instructed to tuck thumb into palm and make a fist around the thumb
Pt then actively performs ulnar deviation
(+): stretch/pain is felt as pt performs action = Means: DeQuervain’s syndrome/extensor pollicis tenosynovitis
(-): no stretch/pain is felt as pt performs action = Means: no DeQuervain’s syndrome/extensor policies tenosynovitis
Purpose: scapholunate instability
How to perform:
Pt sits with elbow on table and forearm supinated
Examiner take 1 hand to metacarpals to place wrist in slight extension and ulnar deviation
Examiner’s other hand will palpate to the scaphoid tubercle of tested wrist and then applies a downward pressure to the tubercle
As the pressure is applied to the tubercle, the pt will radially deviate
(+): scaphoid shifts/clunks as mvt occurs and/or pain = Means: scapholunate instability
(-): no scaphoid shift/clunk as mvt occurs and/or pain = Means: no scapholunate instability
Purpose: Median N or ulnar N pathology
How to perform:
Pt is sitting with palm up and arm on the table relaxed
Examiner than take 1 finger and taps on the carpal tunnel (median n) and then taps on the tunnel of Guyon
(+): recreation of numbness/tingling = Means: median or ulnar n pathology
(-): no recreation of numbness/tingling = Means: no median or ulnar n pathology
Purpose: Fracture
How to perform:
Pt sitting with hand on table
To whatever bone or joint needed to be tested (for example a metacarpal) Examiner will flex the finger to the shortest link of the finger to allow clear access for the tested area
Examiner will then flick or tap the end of the
(+): reproduction of pain = Means: fx present
(-): no reproduction of pain = Means: no fx
Purpose: Fx
How to perform:
Pt is sitting with hand relaxed on table
Examiner squeezes fingers together for squeeze test
Or examiner holds both ends of finger or wrist and tries “break the bone” almost
(+): reproduction of pain = Means fx present
(-): no reproduction of pain = Means: no fx
Purpose: Assesses fingers for rotational deformity following trauma (broken fingers, jammed fingers, MCP joint dislocation, flexor tendon injuries, etc)
How to perform:
Pt sits with hands up and palms facing out
Pt’s wrist and fingers are extended
Pt is instructed to flex fingers down towards wrist
Pt should only be flexed at the PIP and MCP joints
Examiner than inspect both hands bilaterally looking at the alignment or symmetry of each
(+): fingers overlap or asymmetrical alignment of the fingers in cascade sign when compared bilaterally = Means traumatic pathology to fingers (broken fingers, jammed fingers, MCP joint dislocation, flexor tendon injuries, etc)
(-): fingers don’t overlap or finger alignment is symmetrical when compared but bilaterally = Means no traumatic pathology to fingers
Purpose: Lunotriquetral instaiblity
How to perform:
Pt is sitting relaxed with hand on table and palm up
Examiner will then find triquetrium with thumb + pointer finger and then with the other same 2 fingers try to palpate the lunate
Examiner will then move move lunate anteriorly and posteriorly shifting the lunotriquetral ligament
(+): laxity or shift is felt as lunate and triquetrium is shifted = Means: lunotriquetral instability
(-): no laxity or shift is felt as lunate and triquetrium is shifted = Means: no lunotriquetral instability
https://www.youtube.com/watch?app=desktop&v=FU1gIwZF8mE&t=0s
Purpose: lunate dislocation
How to perform:
Pt is sitting or standing
Pt is instructed to make a fist in both hands
Examiner then compares both fists looking at the height of the 3rd metacarpophalangeal joint compared to the other metacarpophalangeal joints (especially the 2nd and 4th)
(+): 3rd MCP joint is smaller than the other MCP joints = Means lunate dislocation
(-): 3rd MCP joint is the highest one of the MCP joints on that hand = Means no lunate dislocation
Purpose: Triangular cartilaginous disc integrity or any TFCC injuries
How to perform:
Pt is sitting or standing with elbows flexed to 90° and palms fully supinated
Pt is asked to either place palms flat underneath a table or the examiner will place 1 arm each over the pt’s arms laying their hands on top the wrist joint
Pt is then asked to lift the table or to push against the examiners hands
(+): pt is unable to hold position while lifting up and/or pain = Means TFCC injury
(-): pt is able to hold position while lifting up and/or no pain = Means TFCC injury