Special tests
Special tests are performed to rule injuries out. They are also performed so the athletic trainer has a better understanding of what the injury may be.
Special tests for the hand and wrist include:
Tap/Percussion
Compression Test
Finkelstein Test
Phalen Test
Reverse Phalen Test
Tinel's sign
Murphy's Sign
Valgus Stress Test
Varus Stress Test
Fromet's Sign
Digital Allen's Test
Special tests for the elbow include:
Varus Stress Test
Valgus Stress Test
Tinel's Sign
Pinch Grip Test
Resistive Tennis Elbow Test
Passive Tennis Elbow Test
Golfer's Elbow Test
Hyperextension Test
Elbow Flexion Test
15. Your athlete tells you that he is experiencing pain on the lateral aspect of his wrist just below the first metatarsal. ROM is painful and decreased. Opposition causes a shooting pain to be experienced through the athlete's wrist and lower arm. What are some important tests you would perform? How are these special tests performed?
16. Your athlete tells you that they are experiencing pain one the medial aspect of their elbow. ROM is painful and limited. Pain is also experienced when the athlete performs wrist flexion and pronation. What are some special tests you would perform? How are these special tests performed?
All special tests were retrieved from:
Konin, J., Wiksten, D., Iser, J., Brader, H. (2006). Special Tests for Orthopedic Examination. 3rd Edition
Special tests for the hand and wrist include:
Tap/Percussion
- Test Positioning: The athlete may sit or stand with the affected finger extended. The examiner stands in front of the subject.
- Action: The examiner applies a firm tap to the end of the finger being tested. As an alternative method to taping, the examiner may use a percussion hammer.
- Positive Finding: Pain at the site of injury indicates a fracture. The vibration of tapping along the long axis of the bone will exaggerate pain at the fracture site.
Compression Test
- Test Positioning: The athlete may sit or stand with the affected finger extended. The examiner stands in front of the athlete.
- Action: The examiner holds the distal phalanx and applies compression along the axis of the finger being tested.
- Positive Finding: Pain at the site of injury indicates a fracture.
Finkelstein Test
- Test Positioning: The athlete sits or stands and forms a fist around the thumb. The examiner stands with the proximal hand grasping the athlete's forearm and the distal hand grasping the athlete's fist.
- Action: While stabilizing the athlete's forearm with the proximal hand, ulnarly deviate the athlete's wrist with the distal hand.
- Positive Finding: Pain over the abductor pollicis longus and extensor pollicis brevis tendons distally is indicative of tenosynovitis or de Quervain's disease.
Phalen Test
- Test Positioning: The athlete sits or stands with the distal aspect of both hands in full contact so that both wrists are maximally flexed.
- Action: A steady compressive force is applied through the athlete's forearms so that the athlete's wrists a maximally flexed for 1 minute.
- Positive Finding: Numbness and tingling in the median nerve distribution of the fingers is indicative of carpal tunnel syndrome secondary to median nerve compression.
Reverse Phalen Test
- Test Positioning: The athlete may sit or stand with the palmer aspect of both hands in full contact so that both wrists are maximally extended.
- Action: A steady compressive force is applied through the athlete's forearms so that the athlete's wrists are maximally extended for 1 minute.
- Positive Finding: Numbness and tingling in the median nerve distribution of the fingers is indicative of carpal tunnels syndrome secondary to median nerve compression.
Tinel's sign
- Test Positioning: The athlete sits next to a flat surface
- Action: The examiner taps the volar aspect of the athlete's wrist over the area of the carpal tunnel.
- Positive Finding: Complaints of tingling, paresthesia, or pain by the subject in the area of the thumb, index finger, middle finger, and radial one-half of the ring finger signal a positive sign. This may be indicative of a compression of the median nerve in the carpal tunnel or carpal tunnel syndrome.
Murphy's Sign
- Test Positioning: The athlete may sit or stand. The examiner stands in front of the athlete.
- Action: The athlete is instructed to make a fist. The examiner notes the position of the third metacarpal.
- Positive Finding: If the athlete's third metacarpal is level with the second and fourth metacarpals, a dislocated lunate is indicated.
Valgus Stress Test
- Test Positioning: The examiner maintains stabilization of the proximal bone between the thumb and forefinger, and grasps the distal bone.
- Action: The examiner provides a valgus force to the joint, creating a fulcrum while attempting to "grasp the joint".
- Positive Finding: Any excessive gapping that is noted when compared to the uninvolved side may indicate a collateral ligament tear.
Varus Stress Test
- Test Positioning: The examiner maintains stabilization of the proximal bone between the thumb and forefinger, and grasps the distal bone.
- Action: The examiner provides a varus force to the joint, creating a fulcrum while attempting to "gap the joint".
- Positive Finding: Any excessive gapping that is noted when compared to the uninvolved side may indicate a collateral ligament tear.
Fromet's Sign
- Test Positioning: The athlete may sit or stand. The examiner sits next to the athlete.
- Action: The athlete is instructed to hold a piece of paper between the thumb and index finger. The examiner then tries to pull the paper out.
- Positive Finding: Flexion if the athlete's distal interphalangeal joint of the thumb is indicative of adductor pollicis paralysis due to ulnar nerve damage.
Digital Allen's Test
- Test Positioning: Both the athlete and the examiner may sit or stand.
- Action: The athlete is instructed to make a fist several times in succession in order to "pump" the blood out of the hand and fingers. The athlete is then instructed to maintain a fist while the examiner compresses the radial artery with the fingers. The examiner then releases pressure from one artery at a time and observes the color of the hand and fingers.
- Positive Finding: A delay in or absence of flushing of the radial or ulnar half of the hand and fingers is indicative of partial or complete occlusion of the radial or ulnar arteries.
Special tests for the elbow include:
Varus Stress Test
- Test positioning: The athlete sits with the test elbow flexed to 20-30 degrees. The examiner stands with the distal hand around the athlete's wrist and the proximal hand over the athlete's elbow.
- Action: With the wrist stabilized, the examiner applies a varus stress to the elbow with the proximal hand.
- Positive Finding: Lateral pain or increased varus movement with a diminished or absent end feel is indicative of damage to the radial (lateral) collateral ligament.
Valgus Stress Test
- Test positioning: The athlete sits with the sits with the elbow flexed to 20-30 degrees. The examiner stands with the distal hand around the athlete's wrist and the proximal hand over the subject's elbow joint.
- Action: With the wrist stabilized, the examiner applies a valgus stress to the elbow with the proximal hand.
- Positive Finding: The medial elbow/increased valgus movement with a diminished or absent endpoint is indicative of damage to primarily the ulnar collateral ligament.
Tinel's Sign
- Test positioning: The athlete is seated with the elbow in slight flexion, the examiner stands with the distal hand grasping the subjects wrist.
- Action: With the wrist stabilized, tap the ulnar nerve in the ulnar notch.
- Positive Finding: Tingling along the ulnar distribution of the forearm, hand, and fingers is indicative of an injury to the ulnar nerve.
Pinch Grip Test
- Testing Position: The athlete can be standing or seated.
- Action: The athlete is instructed to pinch the tips of the thumb and index finger together.
- Positive Finding: The inability to touch the tips of the thumb and index finger together is indicative of a positive finding. Touching the pads of the thumb and index finger indicates pathology of the anterior interosseous nerve between the heads of the pronator muscle.
Resistive Tennis Elbow Test
- Test positioning: The athlete is in the seated position. The examiner stabilizes the elbow while palpating the lateral epicondyle.
- Action: With a closed fist, the subject pronates and radially deviates the forearm and extends the wrist against the examiner's resistance
- Positive finding: Pain along the lateral epicondyle of the humerus or objective muscle weakness as a result of complaints of discomfort may indicate epicondylitis.
Passive Tennis Elbow Test
- Test positioning: The athlete sits with the elbow in full extension
- Action: The examiner passively pronates the forearm and flexes the subject's wrist
- Positive Finding: Reports pain along the lateral epicondyle of the humerus may indicate lateral epicondylitis
Golfer's Elbow Test
- Test Positioning: The athlete sits or stands and makes a fist on the effected side. The examiner faces the subject and palpates along the medial epicondyle. The examiner's other hand grasps the athlete's wrist.
- Action: The examiner passively supinates the forearm and extends the elbow and wrist
- Positive Finding: Complaints of discomfort along the medial aspect of the elbow and wrist
Hyperextension Test
- Test Positioning: The athlete sits or stands with the elbow fully extended with the forearm supinated. The examiner grasps the distal humerus at the areas of the medial and lateral epicondyles with one hand, while the other hand grasps the distal forearm.
- Action: The examiner passively extends the the elbow until no further motion is available .
- Positive Finding: Elbow extension beyond 0 degrees is considered hyperextension. A positive finding of hyperextension may be attributed to a torn or stretched anterior capsule of the elbow.
Elbow Flexion Test
- Test Positioning: The athlete may sit or stand. The examiner stands next to the subject.
- Action: The athlete is instructed to maximally flex the elbow and hold this position for 3-5 minutes.
- Positive Finding: Radiating pain into the median nerve distribution in the subject's arm/hand is a positive finding. A positive test is indicative of cubital fossa syndrome.
15. Your athlete tells you that he is experiencing pain on the lateral aspect of his wrist just below the first metatarsal. ROM is painful and decreased. Opposition causes a shooting pain to be experienced through the athlete's wrist and lower arm. What are some important tests you would perform? How are these special tests performed?
16. Your athlete tells you that they are experiencing pain one the medial aspect of their elbow. ROM is painful and limited. Pain is also experienced when the athlete performs wrist flexion and pronation. What are some special tests you would perform? How are these special tests performed?
All special tests were retrieved from:
Konin, J., Wiksten, D., Iser, J., Brader, H. (2006). Special Tests for Orthopedic Examination. 3rd Edition