Special Tests in Wrist and Hand

1. Finkelstein test

Test: tenosynovitis of abductor pollicis longus and extensor pollicis brevis tendon ( de Quervain’s tenosynovitis).

Procedure: patient makes a fist with thumb inside. Passively move wrist into ulnar deviation.

Positive sign: Reproduction of symptom.

  

2. Froment’s sign

Test: ulnar nerve paralysis.

Procedure: grip piece of paper between index finger and thumb. Pull paper away.

Positive sign: flexion of IP (interphalangeal) thumb joint as paper pulled away.

3. Ligamentous instability test for the fingers

Test: stability of collateral ligaments

Procedure: apply varus and valgus force to PIP (proximal interphalangeal) or DIP (distal interphalangeal) joint.

Positive sign: increased laxity.

4. Linburg’s sign

Test: tendon pathology at interconnection between flexor pollicis longus and flexor indicis.

Procedure: thumb flexion into hypothenar eminence and index finger extension.

Position sign: limited extension and reproduction of symptoms.

5. Lunotriquetral ballottement (Reagan’s) test

Test: stability of lunotriquetral ligaments.

Procedure: stabilize lunate and appy posterior and anterior glide to triquetrum and pisiform.

Positive sign: reproduction of symptoms, cripitus or laxity.

6. Watson (scaphoid shift) test

Test: stability of scaphoid.

Procedure: hold wrist in full ulnar deviation and slight extension. With other hand apply pressure to scaphoid tubercle(palmar aspect) and move wrist into radial deviation and slight flexion.

Positive sign: pain and/or subluxation of scaphoid.

7. Phalen’s (wrist flexion) test  

Test: median nerve pathology; carpel tunnel syndrome

Procedure: place dorsal aspect of hands together with wrists flexed. Hold for 1 minute.

Positive sign: tingling in distribution of median nerve.

8. Reverse phalen’s test

Test: median nerve pathology

Procedure: place palms of hands together with wrist extended. Hold for 1 minute.

Positive sign: tingling in distribution of median nerve.

9. Sweater finger sign

Test: rupture of flexor digitorum profundus tendion.

Procedure: patient makes a fist.

Positive sign: loss of DIP joint flexion of one of the fingers.

10. Tinel’s sign

Test: median nerve pathology; carpel tunnel syndrome

Procedure: tap over carpel tunnel

Positive sign: tingling or paraesthesia in median nerve distribution in hand. Furthest point at which abnormal sensation felt indicates point to which the nerve regenerated.

11. Triangular fibrocartilage complex (TFCC) load test

Test: triangular fibrocartilge complex integrity.

Procedure: hold forearm. With other hand hold wrist in ulnar deviation then move it through supination and pronation while applying a compressive force.

Positive sign: pain, clicking, crepitus.