Special Tests of the Wrist, Hand, and Fingers

Special Tests of the Wrist, Hand, and Fingers include five exams to learn for PD, they are:

1. Finklestein's Test 2. Phalen's Test 3. Reverse Phalen's Test 4. Tinel's Sign 5. Digital Allen's Test

What is DeQuervain's disease?

AKA 1st dorsal compartment tendonitis DeQuervain's disease is caused from the irritation or inflammation of the wrist tendons at the base of the thumb. The inflammation causes the compartment (a tunnel/sheath) around the tendon to swell and enlarge, making thumb and wrist movement painful.

Digital Allen's Test How is this test performed? How do you know the test is "positive"?

Instruct patient to rapidly open and close the hand being tested 15 times As soon as the pt finishes, place your thumbs over both the radial artery and the ulnar artery. Ask the pt to open their hand while still occluding both arteries; the hand should be pale Release one artery; the hand should turn pink again immediately If the hand doesn't turn pink in 6 seconds, or becomes cyanotic, the test is considered positive for poor circulation through the distal extremities

Finkelstein's Test -How is this test performed? -What do you expect for a positive vs negative test?

Instruct the (sitting or standing) pt to make a fist with their thumb tucked inside and have them ulnar deviate. Observe the pt to see if they experience pain upon ulnar deviation. -If the pt experiences pain, specifically over the 1st extensor compartment of the wrist, the test is positive, as that is an abnormal result. -The test is negative if the pt is does not feel pain radiating up the inside of his/her arm from the base of the thumb.

Tinel's Sign at Carpal Tunnel What is the purpose of this test? How is this test performed?

Purpose: Tinel test is used to assist in the diagnosis of carpal tunnel syndrome which is caused by compression of the median nerve. Process: The Tinel sign is elicited by percussing the skin over the median nerve just proximal to the carpal tunnel. Differentials: Some common causes of median nerve compression can include trauma, arthritis, stress from repetitive motions, and obesity.

Tinel's Sign at Carpal Tunnel What are the results of this test?

Results: If this produces tingling or paresthesia in the median nerve distribution (radiating to the thumb, index, middle, and radial-side of ring finger) then the test is positive.

Reverse Phalen's What is the purpose of this test? How is this test performed? Positive if?

Test for Carpal Tunnel Syndrome Explanation -patient places the palms of both hands together (fingers pointed up) with maximal wrist extension for one minute Positive if: Numbness or tingling in the median nerve distribution (first 3 digits and radial half of 4th digit) Differentials -some causes of carpal tunnel syndrome include: -Diabetes -Fluid retention from pregnancy -Obesity -Autoimmune disorder (RA) -Wrist trauma/fracture -HTN

Phalen's What is the purpose of this test? How is this test performed? When would the test be considered "positive"? Differentials -some causes of Carpal Tunnel Syndrome include: -Diabetes -Fluid retention from pregnancy -Obesity -Autoimmune disorder (RA) -Wrist trauma/fracture -HTN

Test for Carpal Tunnel Syndrome Performed: Patient places the back of both hands together (fingers pointed down) with maximal wrist flexion for one minute Positive if -numbness or tingling in the median nerve distribution (first 3 digits and radial half of 4th digit)

Finkelstein's Test What is the purpose of this test? Differentials: -Arthritides -Scaphoid/Snuff Box fracture -Radial Sensory Neuritis -2nd Compartment tenosynovitis -Chauffeur/Radial Styloid/Hutchinson fracture

The purpose of this test is to determine if the pt has Stenosing Tenosynovitis/DeQuervain's Disease, aka 1st dorsal compartment tendonitis, which this test is classically provocative for.

Digital Allen's Test What is the purpose of this test? Differentials: -Ulnar artery stenosis or blockage -Radial artery stenosis or blockage -Raynaud's Phenomenon

The purpose of this test is to test the arterial supply to the hand. It is useful in patients who need to have access in either the radial or ulnar arteries and for selecting patients for radial artery harvesting. If there are no issues with obstruction or stenosis of either the radial or ulnar arteries, the hand will return to its pink color after releasing one of the arteries.