SPECIAL TESTS FOR THE PHYSICAL EXAM OF THE Wrist
The physical examination of the wrist should include a standardized exam approach as well as a series of special tests to help diagnose the cause of the patients wrist pain. In general, a thorough physical examination will include inspection, palpation, active and passive range of motion, strength, neurovascular and special tests. The purpose of today’s post is to review some of the special tests for the wrist exam that all members of the sports medicine team should be familiar with. We will review some of the more commonly used exam techniques but it is worth mentioning there are dozens of others that are not covered here. It is also worth noting that some of these examination techniques may overlap with more than one disease process.
Finkelstein’s Test. There is some controversy around this first test. Finkelstein originally described grasping the thumb and pulling in traction and ulnar deviation. This is the original Finkelstein’s. Eventually, Eichoff suggested what is now recognized as Finkelstein’s test. In this iteration, the patient makes a fist around their thumb in a neutral position and then either actively or passively apply ulnar deviation.
TFCC Stress Test. This is sometimes called the TFCC Compression Test. The TFCC (Triangular Fibrocartilage Complex) stress test involves moving the affected wrist into ulnar deviation and applying a shearing or stress force to recreate the pain.
Sharpey’s Test. The examiner firmly grips the distal radioulnar joint and proximal carpal row. Then apply a compressive force of the carpus into the DRUJ. Then add a rotation force in pronation and supination. A positive test is pain or clicking at the TFCC.
Durkan’s Test. Although Phalen’s and Tinel’s are commonly taught, Durkan’s is likely a better test. Sometimes this examination technique is called the carpal tunnel or medial nerve compression test. It involves applying direct pressure over the median nerve within the carpal tunnel long enough to blanch the skin. This typically takes about 30 seconds. A positive test is reproduction of the symptoms.
Scaphoid Shift Test. The examiner places their thumb on the scaphoid tubercle on the palmer side, other fingers placed on the distal radius. The other hand holds the patients hand at the metacarpals. The wrist is slightly extended with ulnar deviation. This position is then inverted to radial deviation and slight palmer flexion. During this maneuver, the examiner is applying constant pressure with their thumb on the scaphoid tubercle. A positive test is dorsal shift or displacement of fracture fragment. When pressure is removed, fragment will spontaneously reduce.
Reagan’s Test, Sometimes called the lunotriquetral ballottement test. The examiner pronates the affected hand and stabilize the lunate. They then push up on the triquetrum and down on the lunate. Examiner should observe for tenderness or pain and compare to the contralateral hand. A positive test includes pain, subluxation or crepitus.
Thumb CMC Grind Test. The examiner grips the metacarpal bone of the thumb and applies an axial load. Optional: move in gentle circles. A positive test is pain or crepitus.
Pronator Teres Syndrome Test. The patient is standing, elbow flexed to 90°. The examiner supports the elbow with one hand and uses the other to embrace the patient in a handshake position. The examiner attempts to supinate the patient while the patient resists, attempting to pronate the forearm. While resisting supination, the examiner then passively extends the elbow. A positive test is reproduction of symptoms (pain, parasthesias) in median nerve distribution
|↑1||Image courtesy of https://en.wikipedia.org/, “Finkelstein’s Test”|
|↑2||Goubau, J. F., et al. “The wrist hyperflexion and abduction of the thumb (WHAT) test: a more specific and sensitive test to diagnose de Quervain tenosynovitis than the Eichhoff’s Test.” Journal of Hand Surgery (European Volume) 39.3 (2014): 286-292.|
|↑3||Day, Charles S., Wei Kang Wu, and C. Christopher Smith. “Examination of the Hand and Wrist.” The New England journal of medicine 380.12 (2019): e15.|
|↑4||Chae, Seungbum, Youn-Tae Roh, and Il-Jung Park. “Scapholunate Dissociation: Current Concepts of the Treatments.” Archives of Hand and Microsurgery 25.2 (2020): 77-89.|
|↑5||Image courtesy of musculoskeletalkey.com, “Forearm, Wrist and Hand”|
|↑6||Image courtesy of www.physio-pedia.com/|