Hand and Wrist Special Tests

Introduction

This tutorial provides a comprehensive overview of special tests for assessing hand and wrist pain. Whether you are a physiotherapist or simply interested in understanding these assessments, this guide will help you gain confidence in performing the tests, identifying different pathologies, and enhancing your clinical skills.

Step 1: Finklestein's Test

• Purpose: To assess for De Quervain's tenosynovitis.
• Procedure:
  1. Ask the patient to make a fist with the thumb inside.
  2. Instruct them to tilt their wrist towards the ulna (pinky side).
  3. Positive sign: Pain along the radial side of the wrist.

Step 2: OA Grind Test

• Purpose: To evaluate for osteoarthritis in the carpometacarpal joint.
• Procedure:
  1. Hold the patient's thumb and stabilize the carpometacarpal joint.
  2. Apply axial loading while moving the thumb in a circular motion.
  3. Positive sign: Pain or crepitus during movement.

Step 3: Lunotriquetral Ligament Test

• Purpose: To assess for lunotriquetral instability.
• Procedure:
  1. Stabilize the lunate with one hand.
  2. With the other hand, apply pressure to the triquetrum in a dorsal direction.
  3. Positive sign: Pain or a noticeable shift.

Step 4: TFCC Compression Test

• Purpose: To check for tears in the triangular fibrocartilage complex.
• Procedure:
  1. Grip the patient's wrist with one hand and the distal forearm with the other.
  2. Apply axial compression while moving the wrist into ulnar deviation.
  3. Positive sign: Pain in the ulnar side of the wrist.

Step 5: Piano Key Test

• Purpose: To assess for instability of the distal radioulnar joint (DRUJ).
• Procedure:
  1. Stabilize the forearm with one hand.
  2. Push down on the head of the ulna.
  3. Positive sign: Excessive movement or pain when pushing down.

Step 6: Supination Lift Test

• Purpose: To assess for TFCC injury.
• Procedure:
  1. Ask the patient to place their palms facing up on a surface.
  2. Instruct them to lift the surface while keeping their wrists in a supinated position.
  3. Positive sign: Pain in the wrist during the lift.

Step 7: Watson Test

• Purpose: To evaluate scapholunate instability.
• Procedure:
  1. Place the patient's wrist in slight ulnar deviation.
  2. Apply pressure to the scaphoid bone while moving the wrist into radial deviation.
  3. Positive sign: A painful click or shift of the scaphoid.

Step 8: Phalen's Test

• Purpose: To diagnose carpal tunnel syndrome.
• Procedure:
  1. Ask the patient to flex their wrists and press the backs of their hands together for 30-60 seconds.
  2. Positive sign: Tingling or numbness in the fingers.

Step 9: Tinel's Test

• Purpose: To check for nerve irritation in carpal tunnel syndrome.
• Procedure:
  1. Tap over the median nerve at the wrist.
  2. Positive sign: Tingling or electric sensation in the fingers.

Step 10: Guyon's Tunnel Test

• Purpose: To assess for ulnar nerve entrapment.
• Procedure:
  1. Apply pressure on the ulnar nerve at Guyon’s canal.
  2. Positive sign: Tingling or numbness in the ring and little fingers.

Step 11: Froment's Sign

• Purpose: To evaluate for ulnar nerve palsy.
• Procedure:
  1. Ask the patient to hold a piece of paper between their thumb and index finger.
  2. Attempt to pull the paper away.
  3. Positive sign: Inability to maintain grip, indicating weakness.

Step 12: ECU Subluxation Test

• Purpose: To assess for subluxation of the extensor carpi ulnaris tendon.
• Procedure:
  1. Ask the patient to flex and extend their wrist while you observe the ulnar side.
  2. Positive sign: Subluxation of the ECU tendon.

Conclusion

In this tutorial, we covered essential special tests for the assessment of hand and wrist pain. Each test is designed to identify specific pathologies and can significantly aid in diagnosis and treatment planning. Practicing these assessments will enhance your clinical skills and confidence in evaluating wrist and hand conditions. For further learning, consider exploring related physiotherapy techniques and patient rehabilitation strategies.