REIDER PART 1
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Chapter 4 Hand and Wrist 147

nine long flexor tendons of thc fingers and thumb. Compression of the median nerve at this location is called carpal tunnel syndrome because many different pathologies may be responsible for the compression. Posttraumatic hematoma, rheumatoid synovitis, periph-eral edema, and space-occupying tumors are just a few examples. The adjunctive tests for carpal tunnel syndrome are provocative tests that attempt to evoke or exac-erbate the patients symptoms by incrcasing the pressure in the carpal tunnel.

TinePs Test. The most basie of these tests is TinePs test. To perform TinePs test, the examiner places the patients supinated wrist on a table or supports it with one hand. The examiner then taps briskly with the tip of his or her own long finger over the median nerve between the tlexor carpi radialis and the palmaris longus tendons (Fig. 4—73). TinePs sign is considered to be present if this maneuver elicits uncomfortable sensations of pain or electric shocks shooting into thc hand. TinePs sign is present in many cases of carpal tunnel syndrome.

Carpal Tunnel Compression Test. In the carpal tunnel compression test, the examiner supports the patients wrist, which is supinated and flexed to 20°, with one hand and presses firmly with the opposite thumb or finger over the space between the flexor carpi radialis and the palmaris longus tendons at the distal flexion crease of the wrist. This is the point wherc thc median ncrve enters the carpal tunnel (Fig. 4-74). Compression is maintained for l minutę. Normal individuals may find this mildly uncomfortable. If, however, the compression test elicits symptoms of tingling or numbness in the median nerve sensory distribution in the hand, a carpal tunnel syndrome is usually present. This is the most sensitive test for carpal tunnel syndrome. The faster the symptoms are reproduced, the morę irritated the nerve is.

Phalerfs Test and Reverse Phalen's Test. Phalens test and reverse Phalens test are additional methods of indi-rectly compressing the median nerve at the wrist. In Phalen’s test, the patient is instructed to compress the backs of both hands against each other so that the wrists are flexed a fuli 90° (Fig. 4-75A). In reverse Phalen’s test, the patient presses the palms of both hands against each other so that both wrists are extended a fuli 90“ (Fig. 4-73B). In both tests, the position is maintained for 1 minutę. Carpal tunnel syndrome is suspccted if either maneuver reproduces the patients symptoms and causes aching or tingling in the distribution of the median nerve within a minutę. Many clinicians now consider the carpal tunnel compression test to be morę sensitive than either form of Phalens test and rely on it exclusively. Any problem that limits wrist motion makes it difficult to perform Phalens test.

Ulnar Nerve

Ulnar Nerve Compression Test. Running a distant sec-ond to carpal tunnel syndrome is ulnar nerve compression at the wrist in Guyorts catial. Guyon’s canal is formed on the ulnar sidc of thc wrist by thc pisohamate ligament

Figurę 4-74. Carpal tunnel compression test.