Instability of the inferior radioulnar joint, indicated by excessive joint laxity, loss of normal endfeel, and pain.
The patient opens and closes their hand several times, then squeezes it tightly while the PT compresses the radial and ulnar arteries. The PT then releases one artery at a time to observe blood flow recovery.
Hand swelling through anthropometric measurements.
Ask the patient to make an 'OK' sign. Instead of tip-to-tip prehension, there would be palm-to-palm contact if the test is positive.
Ulnar nerve paralysis.
Capillary refill in the fingers and arterial insufficiency.
For carpal tunnel syndrome.
Increased laxity and pain.
The patient may curve or flex their hands due to the absence of function of the adductor pollicis.
Reproduction of symptoms along the ulnar nerve distribution within 3 minutes.
Replication of symptoms and paresthesias subserved by the median nerve (lateral 1st and 2nd digits).
If forearm supination cannot be observed.
A partial tear or other tendon lesions.
The Watson Test.
To diagnose medial epicondylitis.
Lunate dislocation, shown by the 2nd knuckle being at the same level as the other knuckles when making a fist.
Pain, discomfort, or replication of symptoms during the extension movement.
Pain or replication of symptoms throughout the median nerve distribution.
Ask the patient to shake their hands.
Ask the patient to flex the wrist maximally and hold the dorsal side of the hands against each other for 1 minute.
To assess the TFCC (Triangular Fibrocartilage Complex).
The scaphoid shifts or subluxes dorsally when the thumb pressure is applied and shifts back with a 'thunk' sound when the pressure is released.
Hypersensitivity of the ulnar nerve when tapping on the superficial area of the ulnar nerve in the medial elbow.
The patient is in sitting or standing position with the arm at the side. The PT stabilizes the patient's humerus to prevent any movement and passively extends the patient's elbow while keeping the forearm in neutral position, performing the movement to the point of resistance or end-range.
The patient is relaxed with 90 degrees elbow flexion. The PT stabilizes the elbow and resists pronation motion while passively moving the elbow into extension.
The rupture or integrity of the flexor digitorum profundus.
The patient should be in standing or sitting position with the elbow flexed to 90 degrees and the forearm fully supinated.
The patient should be in a sitting position with the arm in extension, forearm in pronation, and wrist in slight radial deviation.
Apprehension or a painful clunk.
Ulnar or medial collateral ligament instability.
Pain, discomfort, or replication of symptoms.
The PT stabilizes the hand and wrist with one hand, holds the 1st metacarpal with the other, then rotates and compresses the metacarpal around the carpals.
The Jersey test.
To measure the stability of each finger by comparing both hands.
To assess the ulnar collateral ligament of the thumb’s MCP joint for pain or laxity.
It assesses for capsular restriction at the PIP joint or intrinsic muscle tightness.
Paresthesia, numbness, and dull pain in median nerve distributions within 2 minutes.
Reproduction of symptoms in the lateral aspect of the elbow.
The scapholunate ligament of the wrist.
To diagnose tennis elbow.
Sudden pain at the medial epicondyle or replication of symptoms.
The patient sits with the forearm and hand on a table. The PT grabs the lunate with one hand and the triquetrum with the other, then performs a dorsal and palmar glide on the triquetrum.
In Jeanne’s Sign, the patient's thumb hyperextends instead of altering the grip.
Within 3 seconds.
The patient should be in a sitting position with the forearm resting on the thighs and the elbow flexed around 60 to 80 degrees.
In a neutral position on the ulnar side.
The PT fixates the radius with one hand and applies pressure on the palmar prominence of the scaphoid with the thumb, then moves the wrist into ulnar deviation and slight extension.
The patient stands, the PT fixes the humerus in ER, palpates the UCL, flexes the elbow to 30 degrees, and applies a valgus force.
The patient holds a piece of paper using lateral prehension while the PT tries to take it away.
The patient is in sitting or standing position with the PT behind. The PT supports the patient's arm at the elbow, positioning it in about 90 degrees flexion with the forearm in neutral or slight supination. The PT then applies a gentle downward force to the forearm while stabilizing the upper arm, compressing the posterior aspect of the elbow.
The patient is in standing or sitting position with the arms in anatomical position, the elbows maximally flexed, the forearms maximally supinated, and the wrists placed in extension. The patient should maintain this position for up to 3 minutes.
Degenerative changes of the intercarpals of the thumb, such as osteoarthritis (OA) of the thumbs.
The patient's forearm is supinated, and the PT compresses the carpal tunnel.
If the DIP joint can't be actively flexed, it indicates weakness of the FDP muscle. If it can't be passively flexed, it indicates tight retinacular ligaments.
Blood recovery in one hand is slower than the other, indicating an impaired artery.
To assess for gamekeeper’s thumb by replicating pain and symptoms through ulnar deviation.
The patient's hand should be in a relaxed position and facing up, and the PT taps over the carpal tunnel at the wrist.
The patient should be in a sitting position with good posture, shoulders relaxed, and palms pressed together with wrists extended maximally.
Laxity, pain, or replication of symptoms.
The patient stands with the elbow in flexion. The PT stabilizes the forearm and palpates the lateral epicondyle, then passively pronates the forearm, flexes the wrist, and extends the elbow maximally.
Pain or a mechanical sensation such as clicking or popping.
Ulnar nerve paralysis.
It may indicate a rupture of the ulnar collateral ligament.
If the amount of PIP flexion is equal in both positions (MCP joint in extension and flexion).
To place tension on the biceps tendon.
The PT uses the contralateral index finger to try to hook under the biceps tendon, bringing it lateral of the antecubital fossa.
Sitting with elbows in 90 degrees flexion and forearms supinated.
Ask the patient to make a fist and resist pressure applied during wrist extension.
The patient is in a comfortable position. The PT stabilizes the humerus and palpates the lateral epicondyle, then asks the patient to pronate the forearm and resist extension of the third digit (middle finger).
A plica is a soft tissue or inert structure that can impede motion due to sprain, repositioning, or tear, obstructing joint movement.
Pain or a mechanical sensation such as clicking or popping.
If PIP flexion is greater when the MCP joint is passively flexed.
The PT stabilizes the patient's ulna and applies a posteriorly directed force through the pisotriquetral complex.
Bulging of the biceps similar to the cartoon character, Popeye.
The patient stands, the PT fixes the humerus in ER, palpates the radial collateral ligament, flexes the elbow to 20-30 degrees, and applies a varus force.
Disappearance of paresthesia or symptoms.
Replication of symptoms, pain, numbness, or tingling in the median nerve distributions.
Localized pain on the ulnar side of the wrist and replication of symptoms.
Reproduction of symptoms on the dorsal side of the hand.
Proximal biceps brachii tendon rupture.
Using both hands, with one hand placed at the distal musculotendinous junction and the other at the muscle belly.
The finger should be embedded at least 1 cm or sometimes until the DIP, and the PT should be able to pull the tendon forward vigorously.
The stability of the ulna and triquetral articulation and if the TFCC is intact.
To assess for lateral epicondylitis.
Sudden pain at the lateral epicondyle.
The patient sits with the arm resting comfortably. The PT stabilizes the humerus while the forearm is in full supination, then gradually extends the elbow while maintaining supination, looking for signs of discomfort or pain.
Replication of symptoms, pain, numbness, or tingling in the median nerve distributions (thumb, index finger, middle finger, and lateral half of the ring finger).
Pain, numbness, tingling, or replication of symptoms in the median nerve distributions.
The PT stabilizes the patient's scaphoid while the patient actively ulnar and radially deviates the wrist.
Reproduction of symptoms in the lateral aspect of the elbow.
The patient stands while the PT fixates the humerus and palpates the medial epicondyle. The PT then passively supinates the forearm, extends the wrist, and fully extends the elbow.
The patient sits with the arm relaxed at the side. The PT stabilizes the humerus and holds the forearm in pronation, then flexes the elbow while maintaining pronation, looking for signs of discomfort or pain.
To further confirm the assessments in ROM, MMT, Palpation, MOI, and subjective presentations.
They should be tied with other S & O findings to determine the actual problem and how it should be treated.
Because they are not 100% conclusive if not correlated with other S & O findings.
Excessive varus or valgus movement.
It assesses ligamentous instability by applying either inward or outward forces on the elbow.
Increased laxity, change in ROM, pain, or a soft end-feel.
