Liberty Union High School District



Sports Medicine IIHand and Wrist Special TestsName _______________________Valgus and Varus Stress Testing of the WristPatient PositionSitting, elbow flexed to 90°, forearm pronated, and the fingers assuming the relaxed positionExaminer PositionSitting or standing lateral to the wrist being tested.Procedures1. Grasp distal forearm with one hand and the metacarpals with the other2-A. Apply a valgus stress, radially deviating the wrist (UCL)2-B. Apply a varus stress, ulnarly deviating the wrist (RCL)Positive TestPain or laxity compared with the same ligament on the opposite wristImplicationsStretching or tearing of the UCL or RCLWrist Glide TestsPatient PositionSitting, elbow flexed to 90°, forearm pronated, and the fingers assuming the relaxed position of flexionExaminer PositionSitting or standing lateral to the wrist being testedProcedures1. One hand grips the distal radius and the other hand grasps the proximal carpal row.2. A shear force is applied to the wrist by gliding the distal segment in a radial and ulnar direction and then in a volar and dorsal direction.Positive TestPain or significant change in glide compared with the opposite sideImplicationsTear or stretching of the collateral or intercarpal ligaments or trauma to the triangular fibrocartilage. Decreased glide may indicate adhesions and capsular stiffness after injury or surgery.Valgus and Varus Stress Testing of the Interphalangeal JointsPatient PositionSitting or standing, joint being tested is in extensionExaminer PositionStanding in front of the patient, stabilizing the phalanx proximal to the joint being testedProcedures1. Examiner grasps the phalanx distal to the joint being tested 2. Apply a valgus stress and then a varus stressPositive TestIncreased gapping, compared with the same motion on the same finger of the opposite hand, painImplicationsCollateral ligament sprainTest for Laxity of the Collateral Ligaments of the ThumbPatient PositionSitting or standingExaminer PositionStanding in front of the patientProcedures1. Examiner stabilizes the first metacarpal with one hand and its proximal phalanx with the other.2. While stabilizing the first metacarpal with the thumb slightly abducted and extended, the examiner applies a valgus stress to the ulnar collateral ligament.3. Test is repeated with the joint in varying degrees of flexion to evaluate the dorsal capsule of the joint.Positive TestThe ulnar side of the first metacarpophalangeal joint gaps farther than the uninjured side or the patient describes pain (or both)ImplicationsStretching or tearing of the ulnar collateral ligamentPhalen’s TestPatient PositionSitting or standing Examiner PositionStanding in front of the patientProcedures1. Patient places dorsal aspect of both hands in full contact so that both wrists are maximally flexed.2. Apply a steady compressive force through the subject’s forearms so that the wrists are maximally flexed for 1 minute.Positive TestNumbness and tingling in the fingers (due to compression of median nerve)ImplicationsCarpal Tunnel SyndromeFinkelstein’s TestPatient PositionSitting or standingExaminer PositionStanding in front of patientProcedures1. Patient makes a fist around the thumb.2. Examiner grasps the patient’s forearm and fist with the patient’s thumb in the examiner’s thenar eminence.3. While stabilizing the patient’s forearm, ulnarly deviate the patient’s wrist.Positive TestPain over the abductor pollicis longus and extensor pollicis brevis tendons ImplicationsTenosynovitis (de Quervain’s disease)Tap TestPatient PositionSitting or standingExaminer PositionIn front of patientProcedures1. Patient extends affected finger.2. Examiner applies a firm tap to the end of the finger being tested.Positive TestPain ImplicationsFractureCompression TestPatient PositionSitting or standingExaminer PositionIn front of patientProcedures1. Examiner holds the distal phalanx and applies compression along the long axis of the bone of the finger being tested.Positive TestPain ImplicationsFractureTinel’s SignPatient PositionSitting with hand palm up on tableExaminer PositionSitting beside patientProcedures1. Examiner taps on the volar aspect of the subject’s wrist over the area of the carpal tunnel.Positive TestTingling, paresthesia, or pain by the subject in the area of the thumb, index finger, middle finger, and radial one-half of the ring finger.ImplicationsCarpal Tunnel Syndrome, compression of the median nerveMurphy’s SignPatient PositionSitting or standingExaminer PositionStanding in front of the subjectProcedures1. Subject makes a fist.2. Examiner notes the position of the third metacarpal.Positive TestThird metacarpal is level with second and fourth metacarpalImplicationsDislocated lunate ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download