Wrist Special Tests

Digital Allen's Test 

Steps

• Athlete is sitting or standing 
• Athlete makes a fist several times to "pump" the blood out of the hand and fingers 
• Athlete makes a fist and the examiner compresses the radial artery with the thumb and the ulnar artery with the fingers 
• Athlete relaxes their hand and the examiner releases pressure from one artery at a time, observing the color of the hand and fingers 

Positive Test
Delay or absence of flushing of the radial or ulnar half of the hand and fingers

Positive Test Implications
Partial or complete occlusion of the radial or ulnar arteries

Finkelstein Test 

Steps

• Athlete is sitting or standing and forms a fist around the thumb 
• Examiner grasps the athlete's forearm with the proximal hand and the athlete's fist with the distal hand 
• Examiner stabilizes the athlete's forearm with the proximal hand and ulnarly deviates the athlete's wrist and the distal hand 

Positive Test
Pain over the abductor pollicis longus and extensor pollicis brevis tendons distally

Positive Test Implications
Possible tenosynovitis or pollicis longus and extensor pollicis brevis tendons

Fromet's Sign Test 

Steps

• Patient is asked to hold a piece of paper between the thumb and index finger while the examiner attempts to pull it away 

Positive Test
Flexion of the first IP joint

Positive Test Implications
Adductor pollicis paralysis due to ulnar nerve damage

If a simultaneous MCP extenion occurs this is known as a Jeanne's Sign which is additional ulnar nerve damage

Long Finger Flexion Test 

Steps

• Examiner maintains stabilization of digits in extension except for digit being tested 
• Examiner stabilizes MCP and PIP of digit being tested 
• Examiner asks patient to flex DIP 

If suspected flexor digitorum superficialis rupture repeat without stabilization of PIP and ask patient to flex PIP

Positive Test
Loss of flexion of DIP
Loss of PIP flexion

Positive Test Implications
Flexor digitorum profundus rupture or nerve damage
Flexor digitorum profundus and superficialis rupture or nerve damage

Phalen Test 

Steps

• Athlete is sitting or standing with the dorsal aspect of both hands in full contact so that both wrists are maximally flexed 
• Athlete applies a steady compressive force through the forearms so that the wrists are maximally flexed for 1 minute 

Positive Test
Numbness and tingling in the median nerve distribution of the fingers

Positive Test Implications
Carpal tunnel syndrome or median nerve compression

Scaphoid Shift Test

Steps

• Examiner opposite athlete, both elbows on table as if arm wrestling ipsilateral arms.
• Examiners thumb on scaphoid tubercle, index finger on scapholunate ligament to palpate clunk. SLL initiates scaphoid flexion on radial deviation of wrist. Completion of flexion of scaphoid caused by pressure from surrounding bones.
• Normal- can feel scaphoid flexing in radial deviation, thumb pushed away.

Original Description by Watson:
'The patient is approached by the examiner as if to engage in arm wrestling, face to face across a
table with diagonally opposed hands raised (right to right or left to left) and elbows resting on the
surface in between. With the patient's forearm slightly pronated, the examiner grasps the wrist
from the radial side, placing his thumb on the scaphoid tuberosity (as if pushing a button to open
a car door) and wrapping his fingers around the distal radius. The examiner's other hand grasps
at the metacarpal level, controlling the wrist position. Starting in ulnar deviation and slight
extension, the wrist is moved radially and slightly flexed with constant thumb pressure on the
scaphoid. This radial deviation causes the scaphoid to flex. The examiners thumb pressure
opposes this normal rotation, causing the scaphoid to shift in relation to the other bones of the
carpus. This scaphoid shift may be subtle or dramatic. A truly positive test requires both pain on
the back of the wrist (not just where you are pressing on the scaphoid tuberosity), and
comparison with the opposite wrist is essential.'

Positive Test
SLL injury - pressure of examiner's thumb prevents initiation of flexion of scaphoid , then Clunk occurs on sudden pressure from bones. Patient may withdraw hand with pain 'apprehension test'
Must compare to opposite wrist.
20 % of normal people have positive test

Valgus (Ulnar) Stress Test 

Steps

• Examiner maintains stabilization of the proximal bone between the thumb and forefinger and grasps the distal bone 
• Examiner provides a valgus force to the joint 

Positive Test
Excessive gapping and/or pain

Positive Test Implications
Collateral ligament tear/sprain
Varus (Radial) Stress Test

Varus (Radial) Stress Test 

Steps

• Examiner maintains stabilization of the proximal bone between the thumb and forefinger and grasps the distal bone 
• Examiner provides a varus force to the joint 

Positive Test
Excessive gapping and/or pain

Positive Test Implications
Collateral ligament tear/sprain
Valgus (Ulnar) Stress Test

Tinel's Sign Tes

Steps

• Athlete is sitting next to a flat surface 
• Examiner taps the volar aspect of the athlete's wrist over the area of the carpel tunnel 

Positive Test
Tingling, paresthesia or pain in the area of the thumb, index finger, middle finger, and radial one–half of the ring finger

Positive Test Implications
Compression of the median nerve in the carpal tunnel or carpal tunnel syndrome