RELIABILITY/SPECIFICITY/SENSITIVITY Functional testing Test Item Cluster: This test may be combined as a cluster with the Drop-Arm Sign and the Painful Arc Sign to test for the presence of a full-thickness rotator cuff tear. Immediate fracture reduction is required if there is neurovascular compromise, severe displacement or skin tenting. The examiner then stabilizes the triquetrum with a finger and the thumb of one hand and moves the lunate up and down (anteriorly and posteriorly) with the finger and thumb of the other hand. Coordination tests INDICATIONS OF A POSITIVE TEST In the starting position the examiner forcefully presses down on the patient’s arm at the forearm. • The finger joints should be tested in varying degrees of flexion to assess the integrity of the different fibers of the ligament. Ulnar nerve Watson (scaphoid shift) test Pronation and supination. The normal end feel of these movements is bone to bone. Figure 6-4 A and B, Testing the stability of the ulnar collateral ligament in the thumb of a normal individual. CLINICAL NOTES/CAUTIONS Précis of the Forearm, Wrist, and Hand Assessment* Thoracic Outlet Syndrome: Orthopedic Tests Page 4 of 26 recommended. You may also needLOWER LEG, ANKLE, AND FOOTELBOWCERVICAL SPINEPELVISKneeAssessment of PostureLUMBAR SPINETHORACIC SPINE 3. Let us analyze the 5 tests for CTS in detail for a better understanding of the same. Side glide of the wrist When the fingers are flexed, they should point toward the scaphoid tubercle. If the examiner suspects a problem with these structures, passive movement end feels will help differentiate the problem. Opposition of the thumb and little finger The digits are medially deviated slightly in relation to the metacarpal bones. Special Tests for Ligament, Capsule, and Joint Instability It is difficult to identify specific structures as the source of a pathological condition with this test, because it tests multiple structures and joints. Thumb abduction and adduction. In addition, a thorough sensorimotor examination of the upper extre… Pain in the forearm and hand are usually the symptoms that send a person to the doctor. The tests are most commonly assessed with the forearm in a pronated position, but it can be valuable for the examiner to test the patient’s active range of motion (ROM) with the forearm in neutral and in a supinated position. THUMB ULNAR COLLATERAL LIGAMENT LAXITY OR INSTABILITY TEST6,7. The arm to be tested should be in about 60 degrees of front flexion with the forearm supinated and the elbow fully extended. The remaining 15° is the result of wrist action. In the starting position the examiner forcefully presses down on the patient’s arm at the forearm. Thumb flexion. The normal end feel of both movements is tissue stretch, although in thin patients, the end feel of pronation may be bone to bone. Instability of the lunotriquetral joint The finger joints should be tested in varying degrees of flexion to assess the integrity of the different fibers of the ligament. For example, if the patient has suffered a fall on the outstretched hand (FOOSH) injury to the wrist, the examiner spends most of the examination looking at the wrist. Finger abduction and adduction. TEST PROCEDURE Testing for: the integrity of the rotator cuff, especially the supraspinatus muscle and tendon. RELIABILITY/SPECIFICITY/SENSITIVITY Valgus movement greater than 30° to 35° indicates a complete tear of the ulnar collateral and accessory collateral ligaments. • If the patient complains of pain on supination, the examiner can differentiate between the distal radioulnar joint and the radiocarpal joints by passively supinating the ulna on the radius with no stress on the radiocarpal joint. Rheumatoid arthritis If you are interested in learning more advanced content, we urge you to look at our insider access pages.These focus on … With the other hand, the examiner grasps the finger distal to the test joint and places the joint in the resting position. As a result, instability is common after trauma and persists without the neuromuscular system contribution. Examination (sitting) MRIs use radio waves to create a … There is also a wrist and hand scan that may be done. Tang5 reported that 30% of patients with distal radius fractures also have carpal instability. Finger adduction The uninvolved hand is tested first. If the force is placed over other bones, the results may not be true indications of the status of the lunotriquetral joint. These movements occur in a plane at right angles to the flexion-extension plane. The examiner stands with the distal hand around the athlete's wrist and the proximal hand over the athlete's elbow. Degeneration of the TFCC begins in the third decade of life and progressively increases in frequency and severity in subsequent decades. EXAMINER POSITION The examiner folds and fans the hand, feeling the movement while monitoring motion and feeling for crepitus and joint motion. Finger adduction (0°) occurs at the same joint. The examiner holds the scaphoid and trapezium with the index and middle finger of one hand and the pisiform and hamate of the other hand while the capitate is held with the thumbs on the dorsum of the hand. Apply gentle pressure to examine your... 2. During flexion of the wrist, the motion is more midcarpal and less radiocarpal. If the examiner suspects a problem with these structures, passive movement end feels will help differentiate the problem. Unknown Watson (Scaphoid Shift) Test Joint Play Movements. To assess the integrity of the collateral ligaments of the metacarpophalangeal and interphalangeal joints of the fingers. It is associated with medial rotation of the thumb as a result of the saddle shape of the carpometacarpal joint. Figure 6-3 Position for testing ligamentous instability of the fingers. Extension of the thumb occurs at the interphalangeal joint (0° to 5°); it is associated with lateral rotation. Ulnar collateral ligament injuries to the thumb occur nine times more frequently than radial collateral ligament injuries. Fanning and folding of the hand If active movement is painful, no overpressure should be added. 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