Provocative tests for the elbow, wrist and hand

Provocative testing is an important component of clinical evaluation of the hand, wrist and elbow. The clinical use of provocative tests is an integrate part of trying to determine either the presence or absence of pathology, that may involve nerves, tendons, ligaments, joint capsules, bones and articular cartilage. The current review attempted to rate the tests according to the likelihood ratio of the test.

The purpose of this quantitative narrative review was firstly to identify and describe provocative tests that are able to determine the presence or absence of pathology in the hand, wrist and elbow; secondly it aims to provide assistance for clinicians in choosing the most useful tests for determining the presence or absence of pathology.

This review illustrates a few tests that can be considered useful in etablishing the presence or absence of pathology as part of the clinical reasoning process. 

6 tests were considered as "highly recommended". 14 tests were considered as being "recommended". 24 tests are at the present time considered to be not useful, due to the fact that they have have not been tested sufficiently to determine their applicability. For 3 tests, no recommendations could be given.

The 6 tests that were considered highly recommended tests included the Phalen’s, Tinel’s, and modified compression tests for carpal tunnel syndrome; the scaphoid shift test for scapholunate instability and the Tinel’s and elbow flexion tests for cubital tunnel syndrome.

> From: Valdes et al., J Hand Ther 28 (2016) 32-42. All rights reserved to Elsevier Inc. Click here for the Pubmed summary.