Hand Tests
Froment's test
Froment's sign is a special test of the wrist. It tests for palsy of the ulnar nerve, specifically, the action of adductor policis. Froment sign can also refer to cogwheel effect seen in essential tremor.
Patient position:
Seated comfortably, with a hand holding a piece of paper (or a flat object).
Therapist position:
In front of the patient, holding the same piece of paper by the other side.
Action of the test:
To perform the test, the patient is asked to hold an object, usually a flat object such as a piece of paper, between their thumb and index finger (pinch grip). The examiner then attempts to pull the object out of the subject's hands.
Positive result:
A normal individual will be able to maintain a hold on the object without difficulty. However, with ulnar nerve palsy, the patient will experience difficulty maintaining a hold and will compensate by flexing the flexor pollicis longus of the thumb to maintain grip pressure causing a pinching effect. Clinically, this compensation manifests as flexion of the interphalangic joint of the thumb (rather than extension, as would occur with correct use of the adductor pollicis).
The compensation of the affected hand results in a weak pinch grip with the tips of the thumb and index finger, therefore, with the thumb in obvious flexion.
Manoeuvre in 8
Position of the patient:
The patient is seated comfortably in front of the therapist, with his arm extended and his forearm supinated.
Therapist position:
The therapist is seated in front of the patient, holding his hand.
Action of the test:
The therapist fixes the wrist of the patient with one hand, while is performing a manoeuvre describing the shape of the number 8 in the hand of the patient.
Positive result:
During the manoeuvre, the therapist will check any lack of movility, noting the direction which is restricted, and will compare it with the other hand.
Special considerations:
This manoeuvre can be used to check the movility of the wrist and also to treat and correct any lack of movement in this joint.
Tinel's test
The purpose of this test is to detect the irritation of the median nerve in the Carpian Tunnel.
Patient position:
Seated comfortably, with the elbow extended and the hand supinated on a table.
Therapist position:
Seated in front of the patient, one hand is fixing the forearm which is going to be tested.
Action of the test:
This test is performed by lightly tapping over the nerve to elicit a sensation of tingling or "pins and needles" in the distribution of the nerve
Positive result:
In Carpal Tunnel Syndrome where the median nerve is compressed at the wrist, Tinel's sign is often "positive" causing tingling in the thumb, index, middle finger and the radial half of the fourth digit. Tinel's sign is sometimes referred to as "distal tingling on percussion". This distal sign of regeneration can be expected during different stage of somatosensory recovery.
Varus/valgus stress test
The purpose of the varus/valgus stress test of the fingers is to assess the integrity of the collateral ligaments.
Patient position:
Seated comfortably, with his hand over a table.
Therapist position:
Seated in front of the patient, holding his hand.
Action of the test:
The therapist places the patient's finger in slight flexion while palpating the interphalangical joint line. The therapist then applies a varus and valgus force to the fingers.
Positive result:
This test is considered positive if the patient experiences pain or excessive laxity is noted compared to the other fingers of the same hand, and of the contralateral hand. The test can be repeated in varying degrees of finger flexion.
Allen's test
Position of the patient:
The patient is seated comfortably in front of the therapist, with his arms extended and the forearms supinated.
Position of the therapist
In front of the patient, holding his hand.
Action of the test:
The examiner Instructs the patient clench his/her fist, or if the patient is unable, he may close the hand tightly.Then he applies occlusive pressure to bothe the ulnar and radial arteries. This manoeuvre obstructs blood flow to the hand, while the patient is relaxed. Blanching of the palm and fingers should occur (if it doesn't, it means that the therapist is not pressing enough the arteries). Later he asks the patient to flex and extend the fingers rapidly. After 5-15 seconds, examiner releases the occlusive pressure on the ulnar artery. The therapist compares with the other hand. After the ulnar artery, he does the same with the radial artery.
Positive result:
The normal flushing of the hand is considered to be a positive modified Allen’s test. A negative modified Allen’s test is one in which the hand does not flush within the specified time period. This indicates that ulnar circulation is inadequate or nonexistence. The radial artery supplying arterial blood to that hand should not be punctured.
Special considerations:
To test the radial artery, the therapist performs the same manoeuvre but pressing the radial artery instead of the ulnar artery.
Bunnel Littler's test
This test evaluates the source of PIP flexion motion limitation by differentiating between intrinsic muscle or capsular tightness in the affected digit. A typical patient presentation may include pain located in the distal intermetacarpal space and with prolonged gripping or making a fist. Symptoms are most often seen in the ring and long finger.
Patient position:
Seated or standing, with the metacarpophalangical joint lightly extended.
Therapist position:
In front of the patient, holding his hand.
Action of the test:
the therapist passively flexes the PIP making note of the available range. The test is then repeated with the MCP flexed.
Positive result:
If no change in motion is detected between the two tests, then capsular restriction at the PIP joint is implicated. If the motion increases when the MCP is flexed, then lumbricale muscle tightness is implicated.
Special considerations:
The therapist holds the extension and the flexion of the MCP joint while he's testing each posture to test the motion of the PIP joint.