Orthopedic manual test for the wrist joint

1. ORTHOPEDIC TEST FOR
THE WRIST JOINT
BY
MAIVA HEZEKIAH AYUBA

2. Phalen’s Test
 Aim of the test: Identifies carpal tunnel compression of median nerve.
 Patient position: Patient maximally flexes both wrists holding them against each other
for one minute.
 Positive sign: Reproduces tingling and/or paresthesia into hand following median nerve
distribution

3. Reverse Phalen’s Test
 Aim of the test: This test is used for carpal tunnel syndrome where median nerve
gets entrapped.
 Test– Patient is asked to fully dorsi flex both wrist for 1 minute.
 Interpretation– This maneuver produces or increases the paresthesia (tingling or
numbness sensation) at the region of median nerve distribution is suggestive
of carpal tunnel syndrome.

4. Tinel’s Test
 Aim of the test: check for median nerve entrapment
 Test– Examiner gently taps or perform percussion over median nerve at the wrist
 Interpretation– Any tingling or numbness sensation in the region of distribution of
median nerve is suggestive of median nerve entrapment.

5. Finkelstein test
 Aim of the test: Identifies De-Quervain's tenosynovitis (paratendonitis of the
abductor pollicis longus and/or extensor pollicis brevis).
 Patient position: Patient makes fist with thumb within confines of fingers.
Passively move wrist into ulnar deviation.
 Positive sign: Reproduces pain in wrist. Often painful with no pathology, so
compare to uninvolved side.

6. Durkan’s Test
 Aim of the test: This test is for carpal tunnel syndrome
 Test– The median nerve is compressed under flexor retinaculum by the examiner for
60 seconds.
 Interpretation: Any tingling or numbness sensation in the region of distribution of
median nerve is suggestive of median nerve entrapment.
 Note:This is most sensitive test for carpal tunnel syndrome.

7. Murphy's Sign
 Aim of the test: to check for dislocation of the lunate.
 Procedure: Ask the patient to make a fist, as the examiner, visually inspect the dorsal
aspect of the hand. Normally the knuckle formed by the head of the third metacarpal
is more prominent and protrudes further distally as compared to the knuckles of the
second and fourth metacarpal heads.
 positive sign is indicative of a lunate dislocation, that's if the knuckle of the third
metacarpal head is level with the knuckles of the second and fourth metacarpal heads,

8. Anatomical Snuffbox Compression Test
 Aim of the Test: to check for scaphoid fracture
 Patient position: The patient should rest the involved forearm on the table. Then, ask the
patient to extend the thumb so that these tendons become prominent. The examiner should
then press in the anatomical snuffbox, applying compression to the scaphoid navicular bone.
 Positive sign: Pain with palpation of the snuffbox is indicative of a scaphoid fracture,
particularly if the patient also has pain in the same area with passive wrist hyperextension.

9. Mallet Finger Test
 Aim of the test: Assesses extensor tendon integrity at the DIP joint.
 Procedure: Position the patient with the forearm in pronation and the hand relaxed on
the table surface. Isolate the tendon by holding the involved finger at the middle
phalanx. Begin with the D.I.P. joint relaxed in flexion. Instruct the patient to extend the
D.I.P. joint.
 positive sign: Inability to extend the D.I.P. joint is indicative of extensor tendon
avulsion at its attachment on the base of the distal phalanx.

10. Bunnel-Littler Test
 Aim of the test: Evaluates the tightness of the hand's intrinsic muscles.
 Procedure: Position the patient with the forearm in pronation and the hand
relaxed on the table. To perform the test, hold the metacarpophalangeal joint in a
few degrees of extension and move the proximal interphalangeal joint into
flexion.
 positive sign: If, in this position, the P.I.P. joint can be flexed, the intrinsic
muscles are not tight and are not limiting flexion.

11. Reference
Flynn, T.W., Cleland, J.A., Whitman, J.M. (2008). User's guide to the musculoskeletal
examination: Fundamentals for the evidence-based clinician. Buckner, Kentucky:
Evidence in Motion
Dutton, M. (2008). Orthopaedic: Examination, evaluation, and intervention (2nd ed.).
New York: The McGraw-Hill Companies, Inc.
Magee David J: Orthopedic Physical Assessment, 6e (Musculoskeletal Rehabilitation),
2013. Elsevier Saunders.
Gross et al: Musculoskeletal examination, 4th ed, 2016. Wiley & Sons, Ltd
positive sign: