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Minnesota State University, Mankato
Minnesota State University, Mankato

Special Tests

Page address: http://ahn.mnsu.edu/athletictraining/spata/wristhandfingermodule/specialtests.html

Tap/Percussion Test

Steps
Athlete is sitting or standing with finger extended
Examiner applies a firm tap to the end of the finger being tested
Positive Test
Pain at the site of injury
Positive Test Implications
Possible fracture

MP Torsion/Grind/Compression, Transverse Compression Test

Steps
Athlete is sitting or standing with finger extended
Examiner holds the distal phalanx and applies compression along the axis of the bone of the finger being tested
Positive Test
Pain at the site of injury
Positive Test Implications
Possible fracture

Finkelstein Test

Steps
Athlete is sitting or standing and forms a fist around the thumb
Examiner grasps the athlete's forearm with the proximal hand and the athlete's fist with the distal hand
Examiner stabilizes the athlete's forearm with the proximal hand and ulnarly deviates the athlete's wrist and the distal hand
Positive Test
Pain over the abductor pollicis longus and extensor pollicis brevis tendons distally
Positive Test Implications
Possible tenosynovitis or pollicis longus and extensor pollicis brevis tendons

Phalen Test

Steps
Athlete is sitting or standing with the dorsal aspect of both hands in full contact so that both wrists are maximally flexed
Athlete applies a steady compressive force through the forearms so that the wrists are maximally flexed for 1 minute
Positive Test
Numbness and tingling in the median nerve distribution of the fingers
Positive Test Implications
Carpal tunnel syndrome or median nerve compression

Tinel's Sign Test (Radial & Ulnar Nerve)

Steps
Athlete is sitting next to a flat surface
Examiner taps the volar aspect of the athlete's wrist over the area of the carpel tunnel
Positive Test
Tingling, paresthesia or pain in the area of the thumb, index finger, middle finger, and radial one–half of the ring finger
Positive Test Implications
Compression of the median nerve in the carpal tunnel or carpal tunnel syndrome

Bunnel Littler Test

Steps
Athlete is sitting with the metacarpophalangeal joint in slight extension
Examiner passively flexes the proximal interphalangeal joint of the same ray and assesses the amount of proximal interphalangeal joint flexion
Examiner then passively flexes the metacarpophalangeal joint slightly and assesses the amount of flexion at the proximal interphalangeal joint
Positive Test
Proximal interphalangeal joint does not flex while the metacarpophalangeal joint is in an extended position
Positive Test Implications
Proximal interphalangeal joint does not fully flex once the metacarpophalangeal joint is slightly flexed, intrinsic muscle tightness can be assumed
If flexion of the proximal interphalangeal joint remains limited once the metacarpophalangeal joint is slightly flexed, capsular tightness can be assumed

Murphy's Sign Test

Steps
Athlete is sitting or standing
Athletes makes a fist and examiner observes the position of the third metacarpal
Positive Test
Third metacarpal is level with the second and fourth metacarpals
Positive Test Implications
Dislocated lunate

Valgus (Ulnar) Stress Test

Steps
Examiner maintains stabilization of the proximal bone between the thumb and forefinger and grasps the distal bone
Examiner provides a valgus force to the joint
Positive Test
Excessive gapping and/or pain
Positive Test Implications
Collateral ligament tear/sprain

Varus (Radial) Stress Test

Steps
Examiner maintains stabilization of the proximal bone between the thumb and forefinger and grasps the distal bone
Examiner provides a varus force to the joint
Positive Test
Excessive gapping and/or pain
Positive Test Implications
Collateral ligament tear/sprain

Fromet's Sign Test

Steps
Patient is asked to hold a piece of paper between the thumb and index finger while the examiner attempts to pull it away
Positive Test
Flexion of the first IP joint
Positive Test Implications
Adductor pollicis paralysis due to ulnar nerve damage
If a simultaneous MCP extenion occurs this is known as a Jeanne's Sign which is additional ulnar nerve damage

Digital Allen's Test

Steps
Athlete is sitting or standing
Athlete makes a fist several times to "pump" the blood out of the hand and fingers
Athlete makes a fist and the examiner compresses the radial artery with the thumb and the ulnar artery with the fingers
Athlete relaxes their hand and the examiner releases pressure from one artery at a time, observing the color of the hand and fingers
Positive Test
Delay or absence of flushing of the radial or ulnar half of the hand and fingers
Positive Test Implications
Partial or complete occlusion of the radial or ulnar arteries

Long Finger Flexion Test

Steps
Examiner maintains stabilization of digits in extension except for digit being tested
Examiner stabilizes MCP and PIP of digit being tested
Examiner asks patient to flex DIP
If suspected flexor digitorum superficialis rupture repeat without stabilization of PIP and ask patient to flex PIP
Positive Test
Loss of flexion of DIP
Loss of PIP flexion
Positive Test Implications
Flexor digitorum profundus rupture or nerve damage
Flexor digitorum profundus and superficialis rupture or nerve damage