Special test for Neurological Dysfunction of the Wrist Joint

• Neurological dysfunction is highly suggestive of a particular nerve lesion if they are positive, but they do not rule out the problem if they are negative.
• They may be negative 50 % of the time, or more when the condition exists with the symptoms varying during the day & daily.
• Electrodiagnostic tests are more conclusive.

Name of the special test of the neurological dysfunction of the wrist joint

• Egawa’s sign
• Flick maneuver
• Froment’s paper sign
• Hand elevation test
• Ninhydrin sweat test
• Wrinkle test

Egawa’s sign

• Purpose = This Egawa’s sign is used to check the ulnar nerve palsy.

• Technique = The patient is in a sitting position for the test.
• The patient flexes the middle digit & then alternately deviates the finger radially & ulnarly.
• If the patient is unable to do this Egawa’s sign, the interossei are affected.

• Result = A positive sign is indicative of ulnar nerve palsy.

Flick maneuver

• Purpose = This flick maneuver is used to check the paresthesia in the hand.

• Technique = The patient is sitting or standing position for the test.
• The patient is complaining about the paresthesia in the hand in the median nerve distribution.
• The patient is asked to vigorously shake the hands or flick the wrist joints.

• Result = A resolution of the symptoms after flicking or shaking the hands is considered a positive test.

Froment’s paper sign

• Purpose = This Froment’s paper sign test is used to check the paralysis of the ulnar nerve.

• Technique = The patient is in a sitting position for the test.
• The patient attempts to grasp a piece of paper between the thumb & index finger.
• When the examiner [ therapist ] attempts to pull away from the paper, the terminal phalanx of the thumb flexes because of paralysis of the adductor pollicis muscle, indicating a positive test.

• If at the same time, the metacarpophalangeal joint of the thumb is hyper-extended, the hyper-extension is noted as a positive Jeanne’s sign.

• Both tests, if positive, are indicative of ulnar nerve paralysis.

Hand elevation test

• Purpose = This hand elevation test is used to check the distribution of the median nerve.

• Technique = The patient is in a sitting or standing position for the test.
• The patient raises both hands over the head & maintains the position for at least 3 minutes.

• Result = A positive test is indicated if symptoms are reproduced in the median nerve distribution in less than 2 minutes.

Ninhydrin sweat test

• Purpose = This ninhydrin sweat test is used to check the nerve lesion in the hand.

• Technique = The patient’s hand is cleaned thoroughly & wiped with alcohol.
• The patient then waits 5 to 30 minutes with the fingertips, not in contact with any surface.
• This allows time for the sweating process to be ensured.
• After that waiting period, the fingertip is pressed with moderate pressure against the good-quality bond paper that has not been touched.
• The fingertips are held in place for 15 seconds & traced with a pencil.
• The paper is then sprayed with triketohydrindenespray reagent & allowed to dry.
• The sweat areas stain purple.

• Result = If the change in colour means from white to purple does not occur, it is considered a positive test for nerve lesion.
• The reagent must be fixed if a permanent record is required.

Wrinkle test

• Purpose = This wrinkle test is used to check the wrinkling of the wrist joint.

• Technique = The patient’s fingers are placed in warm water for approximately 5 to 20 minutes.
• The examiner [ therapist ] then removes the patient’s finger from the water & observes whether the skin over the pulp is wrinkled.
• Normal fingers show wrinkling, but denervated ones do not.

• Result = The test is valid only within the first few months after injury.