Test for the capsule & joint instability in the wrist joint

• These tests are applied to the clinic to check the capsule & joint instability in the wrist joint.
• These tests are applied by the physiotherapist [ examiner ] when the patient complains about wrist joint pain.

Name of the Test for the capsule & joint instability in the wrist joint

• Axial load test
• Catch-up clunk test
• Dorsal capitate displacement apprehension test
• Finger extension
• Litchment test

Axial load test

• Purpose = These axial load test is used to check the fracture of the metacarpal or adjacent carpal bones or joint arthrosis.

• Technique = Starting position of the patient for the test is sitting position.
• The patient sits while the examiner [ therapist ] stabilizes the patient’s wrist with the help of one hand.
• With the help of the other hand, the examiner [ therapist ] carefully grasps the patient’s thumb & applies the axial compression.

• Result = Pain & crepitation indicate a positive test for a fracture of the metacarpal or adjacent carpal bones/joint arthrosis.
• A similar test may be performed for the fingers.

Catch-up clunk test

• Purpose = These catch-up clunk test is used to check the instability in the mid carpal or radiocarpal joint.

• Technique = the patient in sitting position for the test
• The patient has the forearm in pronation while radially & ulnarly deviation the wrist.
• Normally, during this movement, the proximal row of carpals rotates from flexion to extension while the distal row translates from anterior [ palmar] to posterior when going from radial deviation to ulnar deviation.

• Result = if there is mid carpal or radio carpal instability during the movement from radial deviation to ulnar deviation the
• proximal row remains flexed & the distal row remains anteriorly & takes longer to translate.

• As the soft tissue restraints become tighter, there is a sudden catch-up of the proximal row into extension & the distal row posteriorly often accompanied by a clunk indicating a positive test.

Dorsal capitate displacement apprehension test:

• Purpose = These dorsal capitate displacement apprehension test is used to check the stability of the capitate bone.

• Technique = Starting position for the patient of the test is sitting position.
• This patient sits facing the examiner.
• The examiner holds the forearm with the help of one hand.
• The thumb of the examiner’s other hand is placed over the palmar aspect of the capitate while the fingers of that hand the patient’s hand in neutral [ no flexion /extension, no radial or ulnar deviation] & apply a counter-pressure when the examiner [therapist ] pushes the capitate posteriorly with the thumb.

• Result = reproduction of the patient’s symptoms, apprehension, or pain indicates a positive test.
• A click or snap may also be heard when the pressure is applied.

Finger extension test

• This test is also known as the shuck test.

• Purpose = this finger extension test is used to check the inflammation, scaphoid instability, radio carpal or mid carpal instability & Kienbock disease.

• Technique = the patient is placed in a sitting position.
• The examiner [ therapist ] holds the patient wrist in flexion position & the examiner instruct the patient for doing to actively extend the fingers against resistance – loading the radio carpal joints.

• Result = pain would indicate a positive test for radiocarpal or midcarpal instability, scaphoid instability, inflammation &Kienbock disease.

Lichtman test

• This Lichtman test is also known as the mid carpal shift.

• Purpose = This Litchment test is also used to check the instability of the mid-carpal.

• Technique = the patient’s forearm is pronated with the help of a handheld in support by the examiner [ therapist].
• The examiner moves the patient’s hand from radial to ulnar deviation while axially compressing the carpus into the radius while applying an anteriorly directed force to the capitate.

• Result = If the distal carpal row jumps or snaps dorsally means from its subluxed position primarily & reproduces the patient’s symptoms, the test is considered positive.