Elbow, wrist, and hand tests
Each test below follows the same pattern: a technique the examiner performs and a positive finding that points to a specific structure or condition.
Elbow special tests
Fracture and ligamentous instability tests
- Elbow extension test
- Patient in seated position attempts to fully extend the elbow
- Positive: patient unable to extend due to possible fracture - imaging will be needed to confirm
- Patient in seated position attempts to fully extend the elbow
- Varus/valgus test
- Patient sitting or supine with elbow flexed to 20 degrees; valgus force applied to test the ulnar collateral ligament, then varus force applied to test the radial collateral ligament
- Positive: joint laxity and possible pain - needs to be performed bilaterally to determine laxity
- Patient sitting or supine with elbow flexed to 20 degrees; valgus force applied to test the ulnar collateral ligament, then varus force applied to test the radial collateral ligament
Muscle and tendon rupture tests
- Biceps squeeze test (for distal biceps tendon rupture)
- Examiner squeezes the biceps muscle belly with the patient’s elbow flexed to about 60-80 degrees, similar to the Thompson test for the Achilles tendon
- Positive: absence of forearm supination when the muscle is squeezed, indicating rupture of the distal biceps tendon at the elbow
- Examiner squeezes the biceps muscle belly with the patient’s elbow flexed to about 60-80 degrees, similar to the Thompson test for the Achilles tendon
Lateral epicondylitis tests
- Cozen’s test
- Patient seated or standing with the elbow extended, forearm pronated, and wrist in slight radial deviation; the patient makes a fist and extends the wrist against the examiner’s resistance while the examiner palpates the lateral epicondyle
- Positive: pain indicates lateral epicondylitis
- Patient seated or standing with the elbow extended, forearm pronated, and wrist in slight radial deviation; the patient makes a fist and extends the wrist against the examiner’s resistance while the examiner palpates the lateral epicondyle
- Mills test
- Patient seated; the clinician palpates the lateral epicondyle with one hand while pronating the patient’s forearm and fully flexing the wrist, elbow extended
- Positive: pain with this maneuver suggests lateral epicondylitis
- Patient seated; the clinician palpates the lateral epicondyle with one hand while pronating the patient’s forearm and fully flexing the wrist, elbow extended
Medial epicondylitis tests
- Reverse Mills test (also called the golfer’s elbow test)
- Patient seated or standing; the clinician stabilizes the patient’s humerus, palpates the medial epicondyle, then passively supinates the forearm, extends the wrist, and fully extends the elbow, stretching the flexor tendons
- Positive: pain with this maneuver suggests medial epicondylitis
- Patient seated or standing; the clinician stabilizes the patient’s humerus, palpates the medial epicondyle, then passively supinates the forearm, extends the wrist, and fully extends the elbow, stretching the flexor tendons
Neurological dysfunction
- Elbow flexion test (Wadsworth test)
- Patient supine with the shoulder in full external rotation and the elbow held in maximal flexion, wrist extended, for one minute
- Tests for ulnar nerve entrapment at the cubital tunnel
- Positive: pain at the medial elbow within the ulnar distribution of the involved side
- Patient supine with the shoulder in full external rotation and the elbow held in maximal flexion, wrist extended, for one minute
Wrist and hand special tests
Ligamentous, capsule, and joint instability
- Interphalangeal joint varus/valgus tests
- Patient in a seated position with fingers supported and stabilized; valgus/varus force applied to the PIP and DIP joints of all digits
- Positive: joint laxity and possible pain - needs to be performed bilaterally to determine the extent of laxity
- Patient in a seated position with fingers supported and stabilized; valgus/varus force applied to the PIP and DIP joints of all digits
Tendon and muscle
Finkelstein’s test and Eichhoff’s test are classic provocative tests for de Quervain’s tenosynovitis: both have the patient make a fist with the thumb tucked inside the fingers, then move the wrist into ulnar deviation (actively for Eichhoff’s test, passively for Finkelstein’s test). The WHAT (wrist hyperflexion, abduction of the thumb) test is a newer version of the same idea, with much higher sensitivity (99%) but lower specificity.
- Wrist hyperflexion and abduction of the thumb test (WHAT)
- Patient in seated position with the wrist hyperflexed and the thumb abducted in full MCP and IP extension. The examiner applies gradually increasing abduction resistance to the thumb.
- Positive: reproduction of pain in the wrist - needs to be performed bilaterally
- Indicates de Quervain’s tenosynovitis in the 1st dorsal compartment (abductor pollicis longus and extensor pollicis brevis), the same structure implicated by a positive Finkelstein’s or Eichhoff’s test
- Patient in seated position with the wrist hyperflexed and the thumb abducted in full MCP and IP extension. The examiner applies gradually increasing abduction resistance to the thumb.
Neurological dysfunction
- Phalen’s test (wrist flexion test)
- Patient in seated position maximally flexes both wrists while holding them together for one minute
- Positive: reproduces tingling sensation or paresthesia in the median nerve distribution
- Indicates carpal tunnel syndrome
- Positive: reproduces tingling sensation or paresthesia in the median nerve distribution
- Patient in seated position maximally flexes both wrists while holding them together for one minute
- Tinel’s test
- Patient in seated position; the therapist taps a palpable peripheral nerve
- Positive: reproduces tingling sensation or paresthesia in the nerve distribution
- Patient in seated position; the therapist taps a palpable peripheral nerve
Vascular dysfunction
- Modified Allen’s test
- With the patient seated, the therapist palpates the radial and ulnar arteries, then has the patient quickly open and close their hand several times before making a fist
- The therapist compresses the radial artery, has the patient open the hand, observes the palm, releases the compression, and observes the radial refill time; the same procedure is then repeated for the ulnar artery
- Positive: abnormal refill time - needs to be performed bilaterally