Pt makes fist w/ thumb inside;

PT stabilizes forearm, uln deviates wrist

 Pain = involvement w/ AbPL & EPB;

+ for tendinitis/paratenonitis or Quervain's disease (UMN lesion, like Hoffman's) if worse on 1 side

PT taps  on carpal tunnel – median nerve

N/T distal to tapping point, at digits 1,2,4 is + test for carpal tunnel

*to track axon regeneration, start at finger tip, proceed proximally up median n. distrib; sx stop at healthy nerve segment

·      Press dorsa of hands to each other (flex wrists) – hold 1 min – this kinks median nerve

if reproduces symptoms, + test for Carpal Tunnel

palms touching, opposite of phalen’s (also median nerve) – hold 1 min

+ test for median nerve pathology and/or Carpal Tunnel

Allen's Test (for circulation)

"maneuver" is for TOS

(for circulation):

Open/close/open/close/open / hold closed;

PT to pinch arteries of wrist w/ finger and thumb

Hold 5-15 secs;

pt opens hand;

watch bloodflow back in (discoloration white to red)

Determines which artery (radial vs ulnar) provides most blood to the hand - do both hands for compare

PT to pinch pt’s fingertip for 3 secs – release, watch for bloodflow to return

(for assessing digital circulation) - compare both hands

Ligamentous linstability test for fingers

Tests colateral ligs of DIPs/PIPs

PT stabilizes prox joint

PT 2H applies vargus/varus stress to digit, on ea hand, compare laxity of involved vs uninvolved

Thumb ulnar collateral lig laxity or instability test:

"skiier's thumb" or "gamekeeper's thumb"

PT puts firm block on 1st metacarpal

Bring pt's thumb into ext

Apply valgus force to MCP:  can put more than 35 degrees?

(for UCL AND Accessory) 

Isolate UCL lig:  flex CMC 30 deg; re-test

If >35 degrees, + test for UCL and/or accessory ligs tear.  If not, consider partial tear (compare both hands).

For "gamekeepers" or "skiers" thumb

(putting valgus stress on, here, is to resist toward ABDUCTION)

Can grip paper btwn thumb and forefinger?

+ test if they try to grip w/ thumb TIP instead of pad - indicates paralysis of ADDUCTOR POLLICIS (Ulnar nerve involvement) 

§  May also see “Jeanne's Sign”- hyperext of CMC -along with it

Have pt sit->stand from chair, pushing up on the arms of chair with both hands

Pain indicates + test for detects unspecific wrist pathology

1.  Hold MCP joint in slight extension;

2.  Passively flex PIP joint

+ test indicated by inability to flex PIP => tight intrinsics and/or joint capsule

3.  Repeat test holding MCP joint in slight flexion;

-PIP flex still limited = tight capsule;

-Full PIP flexion = tight intrinsics

PT holds pt's hand with 1 hand

Other hand loads thumb at MP joint

Pain = + test for degenerative joint disease / OA

pt "shakes hand" in the air to bring normal sensation back

+ for carpal tunnel syndrome