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Orthopaedic tests

Elbow

1. Cozens test for tennis elbow & golf elbow. 

2. Passive tennis elbow test

3. Varus/ valgus stress test. 

4. Tinel test

5. Pinch grip test

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Wrist

1. Tap or percussion test

2. Compression test

3. Finkelstein test

4. Phalen test

5. Tinel test 

6. Forments test

7. Digital Allen Test

8. Bunnel Littler test

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Surface markings

surface marking video

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1. Radial styloid process

2. Scaphoid

3. Trapezium

4. Trapezium/ first metacarpal articulation

5. Lister tubercle

6. Capitate

7. Lunate

8. Ulnar styloid process

9. Triquetrum

10. Pisiform

11. Hook of hamate

12. Metacarpals

13. Metacarpophalangeal joints

14. Phalanges

15. Anatomic snuff box

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Manipulation

Elbow

1. Radial head thrust

2. Lateral epicondyle (common tendon origin/tennis elbow) thrust

video

Wrist

1. First row of carpal bones Anterior/posterior plane

2. Second row of carpal bones Anterior/posterior plane

3. Access individual carpal bones figure 8

4. Biscuit breaking to stretch flexor retinaculum (supination)

5. Torsion mobilise distal radius & ulna (pronation)

6. Manipulation of the carpal bones.  video

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Conditions

Elbow

1. Lateral Epicondylitis (Tennis elbow)

2. Medial Epicondylitis (Golfer's elbow)

3. Elbow Fractures

4. Ulnar Neuritis

5. Olecranon bursitis

6. Deformities of the elbow

7. R.A. of the elbow

Wrist

1. Wrist Sprain

2. Median Nerve injury

3. Ulnar Nerve injury

4. Radial Nerve injury

5. Carpal Tunnel Syndrome

6. Tenosynovitis

7. De Quervain's Disease

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Adjustment

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Lunate 
1st row of carpal bone Adjustment

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Hamate 
2nd row of carpal bone Adjustment

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Tennis Elbow Adjustment

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Radial Head Adjustment

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Orthopaedic Tests

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Tinel Test for carpal tunnel syndrome

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  • Test: Tinel's Test for the Median Nerve.

  • Procedure:

    • Therapist slightly dorsiflexes the patient's hand with the dorsum of the wrist on a cushion.

    • Gently taps the median nerve at the wrist crease using a reflex hammer or dex finger.

  • Findings:

    • Paresthesia distal to the point of pressure.

    • Pain radiating into the hand.

  • Conclusion:

    • Positive findings may suggest a median nerve lesion, tenosynovitis, or carpal tunnel syndrome.

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FINKELSTEIN TEST dequervains disease

  • Procedure: Examiner pulls the patient's thumb in ulnar deviation and longitudinal traction.

  • Positive Result: Increased pain along the radial styloid process, and along the length of the extensor pollicis brevis and abductor pollicis tendons.

  • Indication: Positive for De Quervain's syndrome (tenosynovitis of the thumb tendons).

Finkelstein-Test-1.webp
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PHALENS TEST

  • Procedure: Patient holds their wrists in complete and forced flexion, pushing the dorsal surfaces of both hands together.

  • Positive Result: Burning, tingling, or numb sensation over the thumb, index, middle, and ring finger.

  • Indication: Positive test suggests Carpal Tunnel Syndrome, indicating compression of the median nerve within the carpal tunnel.

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ALLEN TEST

  • Arteries Tested: Radial artery and ulnar artery.

  • Procedure:

  1. Locate and compress radial artery with 3 digits.

  2. Locate and compress ulnar artery with 3 digits.

  3. Ask the subject to clench and unclench the hand 10 times.

  4. Hold the hand open without hyperextending the wrist and fingers.

  5. Observe the palm for blanching.

  • Capillary Refill Test:

  1. Release the ulnar artery and note the time for the palm, especially the thumb and thenar eminence, to become flush.

  2. If capillary refill is less than 6 seconds, the test is considered positive.

  3. Repeat the test with the radial artery.

  • Comparison: Both hands should be tested for comparison.

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BUNNELL LITTHER TEST

  • Test Purpose: Evaluates the source of proximal interphalangeal (PIP) joint motion limitation, often in the ring and middle finger.

  • Technique:

    • MCP joint held in an extended position.

    • Therapist passively flexes the PIP joint, noting the available range.

    • Test repeated with the MCP joint flexed.

  • Interpretation:

    • If no change in motion between the two tests, capsular restriction at the PIP joint is implicated.

    • If motion increases when the MCP is flexed, lumbrical muscle tightness is implicated.

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COZENS TEST lateral epicondylitis

  • Test: Lateral Epicondyle Tenderness Test.

  • Procedure:

    • Examiner stabilizes the patient's elbow with the thumb.

    • Palpates the lateral epicondyle.

    • Patient makes a fist, pronates the forearm, radially deviates, and extends the wrist against resistance applied by the examiner.

  • Positive Result:

    • Reproduction of pain near the lateral epicondyle indicates a positive test.

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TINEL TEST ulnar nerve

  • Test: Ulnar Nerve Tapping Test.

  • Procedure:

    • Therapist locates the ulnar nerve between the olecranon process and the medial epicondyle.

    • Ulnar nerve is tapped repeatedly by the therapist's index finger.

  • Positive Result:

    • A tingling sensation in the ulnar distribution of the forearm and hand distal to the tapping point indicates a positive sign.

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PINCH GRIP TEST (fromets sign)

  • Assessment for Ulnar Nerve Lesion:

  • Procedure:

    • Client grasps a piece of paper between the thumb and the lateral aspect of the index finger.

    • Therapist tries to pull the paper away.

  • Findings:

    • If the thumb flexes to keep the paper in place, it may indicate weakness or paralysis of the abductor pollicis, suggesting a potential ulnar nerve lesion.

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VALGUS VARUS TEST

  • Test: Valgus/Varus Stress Test for the Elbow.

  • Procedure:

    • Seated patient's elbow is flexed at 20-30 degrees.

    • Therapist ensures the patient's forearm is supinated.

    • Applies valgus (for medial stress) or varus (for lateral stress) force to the elbow.

Crystal Salt

Red Flags

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Compartment syndrome

  1. History of trauma or surgery.

  2. Persistent forearm pain and tenderness.

  3. Pain increases with stretching of affected muscles.

  4. Increased tension in the involved compartment.

  5. Tingling, burning, or numbness.

  6. Experiencing parasthesia, paresis, and sensory deficits.

  7. Symptoms remain constant regardless of position or movement.

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Radial Head Fracture

  1. History of falling on an outstretched arm.

  2. Tenderness around the radial head.

  3. Keeping the upper extremity in a high guard position.

  4. Swelling in the elbow joint.

  5. Limited or painful movement in both supination and pronation.

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Avascular necrosis

  1. Pain and stiffness in the upper arm.

  2. Gradual onset of pain.

  3. History of excessive alcohol use.

  4. Long-term use of oral steroids.

  5. Occasionally, a history of chemotherapy and radiation.

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Lunate fracture

  1. Generalized wrist pain.

  2. History of dorsiflexion injury to the hand or fall on an outstretched hand.

  3. Intense pain when gripping things or moving the wrist.

  4. Reduced grip strength.

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Long flexor tendon rupture

  1. Injury on the palm side of the hand.

  2. Numbness in the fingertips.

  3. Pain when bending the finger.

  4. Unable to move or bend specific finger joints (like dip or pip joint).

  5. Forceful flexor contraction.

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Wrist bone fracture - schaphoid

  1. Common fracture in the carpal region.

  2. May involve direct axial compression or hyperextension of the wrist.

  3. Occurs more often in men than in women.

  4. Most common in young men aged 15-29 following a fall, athletic injury, or motor vehicle accident with an outstretched hand.

  5. Symptoms include pain during wrist motion, swelling around the wrist, and tenderness in the wrist and at the base of the thumb.

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Malignancy

  1. Asymmetric or irregular-shaped lesion.

  2. Unexplained deformity, mass, or lesion.

  3. Chronic pain in bones.

  4. Unexplained weight loss.

  5. Extreme tiredness or fatigue.

  6. Repeated infections.

  7. Persistent low-grade fever, either constant or intermittent.

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Infection

  1. Fever, chills, malaise, and weakness.

  2. Recent bacterial infection like urinary tract or skin infection.

  3. Recent cut, scrape, or puncture wound.

  4. Loss of appetite.

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Common injuries 

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Dislocation of radial head

  1. Often associated with significant trauma.

  2. Happens when the radial head is pulled out of the annular ligament.

  3. Results in the displacement of the radial head from its normal position with the humerus and ulna.

  4. In children, the radial head is more often subluxed than dislocated.

  5. More common in adult males subjected to high-force injuries.

  6. Peak incidence occurs in young children under the age of 5, more frequently in girls.

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Lateral epicondylitis/tennis elbow

  1. Condition where the lateral epicondyle of the humerus becomes sore and tender.

  2. Involves acute or chronic inflammation and microtearing of fibers in the extensor tendons.

  3. Results from overuse of the wrist extensor muscles, like extensor carpi brevis.

  4. Affects more than 50% of athletes using overhead arm motions.

  5. Annual incidence is 4-7 cases per 1000.

  6. Peak incidence is at 40-50 years of age.

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Olecranon bursitis

  1. Inflammation of the olecranon bursa, located just above the ulna's proximal end on the extensor aspect.

  2. Characterized by pain, swelling, and redness near the olecranon process.

  3. Often results from prolonged pressure, a single injury to the elbow, mild but repeated minor injuries, infection, trauma, or other conditions that worsen inflammation.

  4. Peak occurrence is at an older age.

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Mallet finger

  1. Injury to the extensor digitorum tendon of the fingers.

  2. Results from the disruption of the terminal extensor mechanism at the distal interphalangeal joint.

  3. Typically occurs when an object strikes the finger, causing forceful flexion of an extended distal interphalangeal joint.

  4. Symptoms include tenderness just behind the nail, pain, and swelling at the end of the injured finger, along with an inability to straighten the tip of that finger.

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De quervain syndrome

  1. Tenosynovitis affecting the sheath involving the abductor pollicis longus and the extensor pollicis brevis.

  2. Usually develops from a direct blow to the wrist, thumb, or tendon, repetitive grasping, overuse of the wrist, and certain inflammatory conditions.

  3. Most commonly occurs in middle age.

  4. Affects women 8-10 times more than men.

  5. Symptoms include difficulty gripping, pain and tenderness with specific wrist movements, and pain along the base of the thumb.

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Carpal tunnel syndrome

  1. Pressure on the median nerve under a thick ligament in the wrist.

  2. Usually from repetitive hand movements.

  3. Common in middle age, especially 30-60 years old.

  4. More common in older women.

  5. Associated with various conditions like hypothyroidism, growth hormone issues, pregnancy, and others.

  6. Causes numbness, tingling, pain, and weakness in the palm and fingers.

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COLLES FRACTURE

  1. Recent fall on an outstretched arm with high-impact wrist extension.

  2. Pain when trying to extend the wrist.

  3. Common in a young male or older female.

  4. Inflammation in the wrist.

  5. Wrist is kept in a neutral position.

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RAYNAURDS SYNDROME

  1. Family history of the phenomenon.

  2. Women undergoing estrogen therapy.

  3. Exposure to extreme cold and associated frostbite injury.

  4. Underlying collagen vascular disease.

  5. Hyperemic erythema and/or cyanosis of the fingers.

  6. Taking medical drugs promoting vasoconstriction (e.g., beta-blockers, amphetamines, decongestants, caffeine).

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