Dr. Ebraheim’s educational animated video describes examination test of the hand.
Adequate evaluation of the hand is necessary for the management of hand and wrist conditions or injury. Knowledge of certain specific tests will help the clinician to reach the correct diagnosis and provide adequate treatment. These are some of the most useful tests that are used frequently for evaluation of wrist and hand conditions.
De Quervain's syndrome: inflammation of the sheath or tunnel that surrounds the two tendons that control movement of the thumb.
Finklestein’s test: the patient makes a fist with the fingers closed over the thumb and the wrist is bent towards the little finger. The hand is pulled so that the involved tendon is stretched, causing a sharp, local pain if injury and inflammation are present.
What is carpal tunnel syndrome? Pressure placed on the median nerve due to thickening of the transverse carpal ligament. Can lead to numbness, tingling or weakness of the hand and fingers.
Tinel’s test: the tinel’s test is used to determine symptoms of carpal tunnel syndrome. The test is considered positive if symptoms of tingling worsen while tapping on the median nerve at the wrist.
•Pahlen’s test: the Phalen’s maneuver is a diagnostic test performed to determine if the patient has CTS. The back of the hands are pressed together, compressing the nerve, which may cause symptoms of CTS.
•Froment’s test: the Froment's test is used to test for palsy of the ulnar nerve which may occur with entrapment of the ulnar nerve within the cutibal tunnel.
What is cubital tunnel syndrome? Occurs due to compression of the ulnar nerve at the elbow.
Froment’s test: when pinching a piece of paper between the thumb and index finger, the thumb IP joint will flex if the adductor pollicis muscle is weak due to ulnar nerve palsy.
•The OK sign is used to check for paralysis of the anterior interosseous nerve due to entrapment or compression injury.
This nerve is a branch of the median nerve that innervates the muscles of the deep group of the anterior compartment of the forearm. Patients with paralysis of the anterior interosseous nerve will unable to make the OK sign.
•Wrist drop: condition of the hand and wrist that determines the presence of radial nerve injury.
•The Allen's test: The examiner applies pressure with the thumbs occluding the ulnar and radial arteries. Patient is asked to make a fist. Patient is then asked to open the hand. When the examiner releases the ulnar artery, the patient;s ulnar artery will cause blood flow to the hand.
What is basal thumb arthritis? Arthritis affecting the thumb joint .
Grind test: by axial loading, pushing and rotating the thumb metacarpal bone, grinding may be felt within the joint.
•Watson’s test: also called the scaphoid shift test, it is diagnostic test used to evaluate scaphoid stability. The examiner places a thumb over the patient’s scaphoid tuberosity which is the distal pole of the scaphoid on the volar surface. The other fingers of the examiner’s same hand are placed dorsally above the radius. The patient’s wrist is placed initially into an ulnar deviation and the examiner's other hand deviates the wrist radially and flexes it slightly. With pressure on the tuberosity of the scaphoid, the scaphoid is pushed dorsally out of the radial fossa. If there is instability of the scaphoid, the test will be positive and produce pain and a “clunk”.
•Lumbrical plus finger: caused by laceration of the flexor digitorum profundus distal to the origin of the lumbricals. Lumbrical is tighter than FDP. Most common in the middle finger. With injury of the flexor digitorum profundus tendon, the patient is unable to maintain the grip when the examiner releases the finger.
•Testing the integrity of the flexor tendon: keep the PIP of the finger extended and see if the patient can flex the DIP. Keep the other fingers extended and then see if the patient can flex the PIP joint of the involved finger. When multiple slips of the superficialis tendon are cut, identify the tendon properly. The superficial tendon of the long and ring fingers are volar at the wrist.
•Bunnell test
•Elson’s test: used to determine if the patient has a central slip tear before the deformity is present.
•When holding a relaxed cascade, the fingers should normally point towards the region of the scaphoid. Malrotation of the finger will causes the affected finger to deviate from its normal rotational direction. Malrotation is especially important with finger metacarpal fractures.
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