Title: Bone Wizardry / OMM Mastery / 18.Special Tests / III.Wrist
Tags: #BW_OMM::Content::Diagnosis #BW_OMM::Region::Upper_Extremity #BW_OMM::Type::Cloze BoneWizardry bonewizardry-free omm omt topic::wrist
On every note of this deck, unless a note says otherwise:
Review Links: - Bone Wizardry upper extremity
- Practice: Wrist and Hand QBank
Show outside sources
- AAFP wrist pain evaluation
- StatPearls Finkelstein sign
- Stanford carpal tunnel exam

Q: The Allen's Test assesses the adequacy of [...] to the hand.
A: blood supply
Q: What test is being described? The patient is instructed to open and close the hand being tested several times and then to make a tight fist. The physician occludes the radial and ulnar arteries at the wrist. The patient is then asked to open the hand. The physician releases one of the arteries and assesses the flushing of the hand.
[...]
A: Allen's Test
Q: What indicates a positive Allen's Test?
[...]
A: If the hand flushes slowly or not at all
Comment: It checks the radial and ulnar arteries.
Comment 3: This indicates that the released artery is not adequately supplying the hand.
Topic: Wrist
Bone Wizardry Lock: Allen's maps arterial dominance at the wrist. Blanch the hand, occlude both arteries, then release one. If the hand flushes slowly or stays pale, that artery alone cannot adequately supply the hand.

Q: The Finkelstein Test assesses for [...].
A: De Quervain's disease
Q: What test is being described? The patient makes a fist with the thumb tucked inside the fingers. The physician stabilizes the patient's forearm and deviates the wrist ulnarly.
[...]
A: Finkelstein Test
Q: What indicates a positive Finkelstein Test?
[...]
A: Pain over the tendons at the wrist
Comment: This is tenosynovitis in the abductor pollicis longus and extensor pollicis brevis tendons at the wrist.
Comment 3: Aka De QuerPain's disease.
Topic: Wrist
Bone Wizardry Lock: Finkelstein provokes De Quervain's tenosynovitis, not carpal tunnel. The pain is at the radial styloid in the APL and EPB tendons, not tingling into the fingers.

Q: The Phalen's Test aides in the diagnosis of [...].
A: carpal tunnel syndrome
Q: What test is being described? The physician maximally flexes the patient's wrist and holds this position for one minute.
[...]
A: Phalen's Test
Q: What indicates a positive Phalen's Test?
[...]
A: Tingling in thumb, index finger, middle and lateral portion of the ring fingers
Topic: Wrist
Bone Wizardry Lock: Phalen's: wrist fully flexed for 60 seconds. Tingling into the thumb, index, middle, and lateral ring finger means the median nerve is being compressed in the carpal tunnel.

Q: What test is being described? The patient extends the wrist while gripping the physician's hand.
[...]
A: Reverse Phalen's Test (Prayer Test)
Comment: Same concept as Phalen's Test, used in the diagnosis of carpal tunnel syndrome, same symptoms are seen.
Topic: Wrist
Bone Wizardry Lock: Reverse Phalen's loads the carpal tunnel with wrist extension under grip instead of flexion. Same median nerve distribution symptoms. Run it when standard Phalen's is borderline or inconclusive.

Q: The Tinel's Test is used in the diagnosis of [...].
A: Carpal tunnel syndrome
Q: What test is being described? The physician taps over the volar aspect of the patient's transverse carpal ligament.
[...]
A: Tinel's Test
Q: What indicates a positive Tinel's Test?
[...]
A: Tingling/paresthesia into the thumb, index, middle and lateral half of the ring finger
Comment: Note: Tinel's Test may also be used in the diagnosis of other neuropathies, such as ulnar nerve entrapment at the elbow; peroneal compression at the fibular head and posterior tibial nerve entrapment at the ankle.
Topic: Wrist
Bone Wizardry Lock: Tinel's at the wrist taps the transverse carpal ligament and sends tingling into the median nerve distribution. The same sign works at other compression sites: ulnar nerve at the elbow, peroneal nerve at the fibular head, posterior tibial nerve at the ankle.

Q: [...] reproduces median-nerve symptoms by sustained wrist flexion.
A: Phalen
Topic: Wrist
Bone Wizardry Lock: Median symptoms plus wrist flexion is Phalen.