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OCS Wrist/Hand

Special Tests

Finkelstein De Quervain Syndrome: First dorsal compartment tenosynovitis. Flex the thumb into the palm and close the fingers around the thumb, then ulnarly deviate the wrist. Positive result is pain in the first dorsal compartment.
First CMC Grind Test OA of the first CMC. Compress the first metacarpal into the trapezium using an axial load to rotate the metacarpal. Positive result is reproducing the patient's pain.
Ulnar collateral ligament stress test Skier's thumb or Gamekeeper's thumb. UCL Rupture. Apply a valgus stress to the MP joint of the thumb at 0 and 30 flexion. Laxity of 30 of 40 degrees with valgus, or more than 15 degrees greater than the contralteral side is positive for rupture.
Watson Test aka Scaphoid shift test. Scaphoid/Lunate dissociation: Palpate the scaphoid and place wrist in ulnar deviation. Maintian pressure on the scaphoid and move the wrist into radial deivation. Positive result: clunk as the scaphoid subluxes.
Scaphoid Ballottement Test aka Scapholunate shear test. Scahoid/Lunate dissoaciation. In pronation, palpate the scaphoid in one hand and the lunate in the other. Then move the scaphoid on the lunate AP. Positive is pain reproduction, laxity, clicking, or crepitus.
Finger extension test Ganglion or dorsal wrist syndrome. With the patient's wrist and MP flexed, resist long finger extension at the MP joint. Positive is pain in the 3rd and 4th extension compartments.
Lunotriquetral Ballottment Test aka lunotriquetral shear test. LT dissociation. In pronation, palpate the lunate with one hand and the pisotriquetral compex with the other, move AP. Positive result is pain reproduction, clikcin, or crepitus.
Ulnar fovea sign distruptions of the DRUJ. With neutral rotation, palpate the soft spot between the ulnar styloid, FCU tendon, the ulnar head and the pisiform. Positive test is pain reproduction.
TFCC Load TFCC lesion, ulnar compaction syndrome. ulnarly deviate the wrist and apply axial load throughou the wrist and ulna; move the carpals on the ulna. Positive test pain reproduction and/or crepitus
Ulnocarpal stress test passively move the patient's wrist into maximum ulnar deviation. Then apply an axial load while pronating and supination the forearm. positive test reproduces the pain in the ulnar wrist.
Ulnocarpal instability test holding the forearm in pronation in a suspended position. Test is positive when the therapist observes a volar 'sag' and a prominent ulnar head.
Piano Key Sign DRUJ instability. with the forearm in neutral rotation, stabilize the radius and press the ulnar styloid volarly. When pressure is released, a positive test, the ulna will spring back up to its original position.
Piano Key Test DRUJ Ballottement DRUJ lesion or instability. While stabilizing the radius, apply volar and dorsal overpressure in ponation and supination. Compare bilaterally. Positive is if the patient complains of pain or excessive laxity.
Ulnar Compression Test DRUJ inflammation or arthritis. Compress the ulnar head into the sigmoid notch then combine this with pronation and supination. Positive result is pain.
Extensor Carpi Ulnaris Subluxation Test Palpate ECU with slight wrist ulnar deviation have the patient slowly rotate the forearm. Positive test is ECU tendon snapping out of the ulnar groove during rotation; may also cause pain.
Midcarpal Instability Test Disruption of the Ulnar Intercarpal ligaments or VISI deformity). neutral pronation, apply a volar force at the capitate whil loading the wrist and ulnarly deviate. Positive test is a painful clunk.
Pisotriquetral Grind Test Degenerative Arthrosis. Apply dorsal pressure to the pisiform. Positive test reproduces pain.
Bunnell-Littler Test Tests for intrinsic muscle tightness. First measure passive PIP joint flexion with MP in extension. then measure with MP flexion. Intrinsic muscles are tight if PIP joint motion increases with MP flexion.
Oblique Retinacular Ligament Test Tests for oblique retinacular ligament tightness or contracture. measure passive DIP flexion with PIP extended; repeat measurement with PIP flexed. ORL is tight if DIP joint motion increases with PIP flexion.
Allen Test Test for Vascular disorders. Compress the radial and ulnar arteries; have the patient open and close the hand; ask them to hold the hand open, and release one artery. Repeat with the other artery. A positive test is when the hand does not re-vascularize.
Froment Sign Tests for weakness of Adductor Pollicus (consistent with Ulnar Nerve Paraslysis). Ask the patient to pinch a piece of pater between the thumb and index finger. Positive test is FLEXION at the thumb IP when you try to pull the paper out.
Phalen's Test Tests for carpal tunnel syndrome. Position the patient with both wrist flexed 9and opposed) hold for at least 30 seconds. Paresthesias along the median nerve distribution is positive.
Tinel's Test Tests for carpal tunnel syndrome. Tap on the volar surface of the wrist over the carpal tunnel. Positive test is pain/paresthesia in the median nerve distribution.
Created by: aschroeder0614