The Wrist and Hand Exam Basics

Carpal Tunnel Syndrome

Tinel's Test

  • Technique

    • Passive Exam

    • Patient seated or standing with the affected hand supinated 

    • Examiner in front or to affected side of patient

    • Examiner extends the wrist with the hand while supinated and repeatedly taps over the carpal tunnel (between the thenar and hypothenar eminences, just distal the the flexor crease) with fingers or a reflex hammer

    • A positive result occurs when the maneuver elicits pain and/or recreation of symptoms in the hand, thumb, index or middle fingers

    • A negative result occurs when there is no symptoms are elicited 

Durkan's/Carpal Tunnel Compression Test

  • Technique

    • Passive Exam

    • Patient seated or standing with the affected at rest

    • Examiner in front or to affected side of patient

    • Examiner, with both hands, flexes the patient's wrist and simultaneously presses over the carpal tunnel.  This position is held for up to 60 seconds.

    • A positive result occurs when the maneuver elicits pain and/or recreation of symptoms in the hand, thumb, index or middle fingers

    • A negative result occurs when there is no symptoms are elicited 

Phalen's Test

  • Technique

    • Active exam

    • Patient seated or standing with back of both hands pressed together with the wrists fully flexed, and raised to chest hight.  This position is held for up to 60 seconds

    • A positive result occurs when the maneuver recreates symptoms in the hand, thumb, index or middle fingers

    • A negative result occurs when there is no symptoms are elicited 

DeQuervain's Tenosynovitis

Finkelstein's Test 

  • Technique

    • Active exam

    • Patient seated or standing with the affected hand in neutral position

    • Patient places the thumb of the affected in the palm, closes the fingers around the thumb, and ulnar deviates the wrist

    • A positive result occurs when the maneuver elicits pain over the radial hand, wrist, forearm

    • A negative result occurs when there is no symptoms are elicited 

Septic Flexor Tenosynovitis

Kanavel Signs

  • Affected finger is flexed 

  • Diffuse finger swelling

  • Finger flexor tendon is tender to palpation

  • Extreme finger pain when it is passively extended

Flexor Tendon Rupture/Laceration

Jersey Finger Sign

  • The affected finger will not actively flex.  

  • If injury is distal to the proximal interphalangeal joint, the finger will still be able to actively flex at the MP and PIP joints

Extensor Tendon Rupture

Mallet Finger Sign

  • The affected finger distal phalangeal joint rests in flexion and is unable to actively extend