- Resisted wrist extension
- Resisted Thumb IP joint extension
Testing FDP. Repeat test for rest of finger FDP.
Testing for FDS. Repeat test for rest of finger FDS.
Principle of carpal tunnel tests:
The clinical tests used for carpal tunnel syndrome are provocative tests that reproduce the paraesthesia in the fingers supplied by the Median nerve.
Place patient forearm in neutral position. Tap with a finger on the Median nerve at the carpal tunnel area where nerve enters the carpal tunnel.
Positive test: paraesthesia in Median nerve distribution.
Both hands together with extended fingers with wrists in flexed position front of body with wrist flexion to 90° with flexed elbows. Keep position for 60 seconds. Positive test: paraesthesia in Median nerve distribution.
Both palms together with wrists in front of body in maximal wrist extension with elbows raised superiorly as in a prayer position. Keep position for 60 seconds. Positive test: paraesthesia in Median nerve distribution.
Place patient forearm in neutral position. Tap with a finger on the Ulnar nerve at the cubital tunnel area where nerve enters the tunnel. Positive test: paraesthesia in ulnar nerve distribution.
Patient requested to hold fingers fully adducted with fingers joints in extension. Positive sign when the little finger drifts away into an abduction position.
Place and grasp paper between thumb and index finger and pull paper away. With Adductor pollcis weakness (Ulnar nerve), inability to have normal adduction function will cause compensatory thumb flexion at the interphalangeal joint.
Patient requested to demonstrate a key pinch movement. Jeanne sign is positive when the metacarpalphalngeal joint is hyperextended.
Grasp patient’s wrist with thumb over scaphoid tubercle on the volar aspect (to stabilize the scaphoid and prevent vertical translation) while the other hand holds the patient’s hand and moves the wrist (wrist in slight flexion) from ulnar to a radial position. With scapholunate ligament instability the scaphoid will sublux over dorsal lip of the radius.
With one hand grasp dorsum of patient’s lunate with index finger over the carpal tunnel while the other hand grasps triquetrum over the volar aspect with index finger over the pisiform. Ballot lunate and triquetrum. Positive test: Displacement of lunate & triquetrum.
Place wrist in neutral position. Hold distal forearm and grasp patient hand and move to ulnar deviation. Positive test : reproduction of pain/click.
Hold patient hand while supporting elbow and move patient’s wrist to maximum ulnar deviation. Apply axial load to the wrist. Passively pronate and supinate the forearm. Positive test: pain reproducible.
Stabilize the pisiform with one hand while the other hand apply a depressive force on the dorsal side of the ulnar, thereby depressing the ulnar in a volar direction. A positive sign is when the ulnar springs back after releasing the depressive force.
Place finger over edge of table with proximal interphalangeal joint (PIP) joint at 90°.
Extend finger PIP joint while examiner palpates the middle phalanx. With a torn central slip (extensor hood) the patient is unable to extend the PIP joint (positive Elson test).
Keep thumb in palm of hand. Passive deviation of wrist to the ulnar side causes local pain for a positive Finkelstein’s test. The Finkelstein’s test is a clinical test to confirm the diagnosis of De Quervain’s tenosynovitis.
Keep thumb in palm of hand. Passive deviation of wrist to the ulnar side causes local pain for a positive Finkelstein’s test.
Apply stress to the thumb metacarpal phalangeal joint in flexion and extension. Positive test when >30°of laxity in both finger flexion and extension or >15° compared to the contralateral side.
Stress testing metacarpal-phalangeal joint: