Tell me about all the nerves there tests with images
Asking for Preferences
Reading File
Finding Sources
Finding Sources
Reading File
Reading File
Reading File
Reading File
Reading File
Finding Sources
Reading File
Reading File
Reading File
Reading File
Searching Images
Tinel sign Phalen test carpal tunnel median nerve
Searching Images
Froment sign ulnar nerve test hand
Searching Images
elbow flexion test cubital tunnel ulnar nerve
Searching Images
wrist drop radial nerve palsy Saturday night palsy
I now have everything I need to write a comprehensive, well-illustrated answer. Let me compile it.
Peripheral Nerve Injury Tests — Complete Guide
🖐️ MEDIAN NERVE TESTS
1. Tinel's Sign
Indication: Carpal tunnel syndrome (CTS) — and any median nerve compression
Technique: Gently tap (percuss) with two fingers over the carpal tunnel on the volar (palmar) surface of the wrist
Positive finding: Electric shock-like tingling shooting into the thumb, index, middle, and radial half of the ring finger
Mechanism: Percussion mechanically stimulates the irritated or regenerating median nerve fibers
Technique: Gently tap (percuss) with two fingers over the carpal tunnel on the volar (palmar) surface of the wrist
Positive finding: Electric shock-like tingling shooting into the thumb, index, middle, and radial half of the ring finger
Mechanism: Percussion mechanically stimulates the irritated or regenerating median nerve fibers
2. Phalen's Test (Phalen's Maneuver)
Indication: Carpal tunnel syndrome
Technique: Patient holds both wrists in maximal flexion (dorsal hands pressed together, fingers pointing down) for 60 seconds. This constricts the transverse carpal ligament and narrows the tunnel.
Positive finding: Reproduction of numbness, tingling, or pain in the median nerve distribution within 30–60 seconds
Technique: Patient holds both wrists in maximal flexion (dorsal hands pressed together, fingers pointing down) for 60 seconds. This constricts the transverse carpal ligament and narrows the tunnel.
Positive finding: Reproduction of numbness, tingling, or pain in the median nerve distribution within 30–60 seconds
3. Durkan Compression Test (Carpal Tunnel Compression Test)
Indication: Carpal tunnel syndrome — most sensitive provocative test for CTS
Technique: Examiner compresses the median nerve directly over the carpal tunnel (thumb on the palm, wrist in neutral) for up to 30–60 seconds
Positive finding: Reproduction of numbness, tingling, or pain in the median nerve distribution
Technique: Examiner compresses the median nerve directly over the carpal tunnel (thumb on the palm, wrist in neutral) for up to 30–60 seconds
Positive finding: Reproduction of numbness, tingling, or pain in the median nerve distribution
"Most sensitive provocative test: carpal tunnel compression test (Durkan test) with wrist in neutral position" — Miller's Review of Orthopaedics, 9th Ed.
4. "OK Sign" / Anterior Interosseous Nerve Test
Indication: Anterior interosseous nerve (AIN) entrapment (purely motor branch of median nerve)
Technique: Ask the patient to form a circle (the "OK sign") with the thumb and index finger
Positive finding: Inability to flex the thumb IP joint and index DIP simultaneously → the patient instead forms a "pinch" posture (precision sign); no sensory loss
Technique: Ask the patient to form a circle (the "OK sign") with the thumb and index finger
Positive finding: Inability to flex the thumb IP joint and index DIP simultaneously → the patient instead forms a "pinch" posture (precision sign); no sensory loss
5. Abductor Pollicis Brevis (APB) Test
Indication: Median nerve motor branch integrity at the wrist (thenar branch)
Technique: Place thumb in palmar abduction (palm up); patient resists force directed toward the palm. Palpate the APB belly to confirm contraction.
Positive finding: Weakness of thumb opposition/abduction = motor branch compromise
Technique: Place thumb in palmar abduction (palm up); patient resists force directed toward the palm. Palpate the APB belly to confirm contraction.
Positive finding: Weakness of thumb opposition/abduction = motor branch compromise
"The best muscle to test in suspected carpal tunnel syndrome is the abductor pollicis brevis, which abducts the thumb perpendicular to the plane of the palm." — Neuroanatomy Through Clinical Cases, 3rd Ed.
✋ ULNAR NERVE TESTS
6. Tinel's Sign at the Elbow
Indication: Cubital tunnel syndrome (ulnar nerve at medial epicondyle)
Technique: Tap over the cubital tunnel at the medial epicondyle
Positive finding: Pain or paresthesias shooting down the ulnar border of the forearm into the 4th and 5th fingers
Technique: Tap over the cubital tunnel at the medial epicondyle
Positive finding: Pain or paresthesias shooting down the ulnar border of the forearm into the 4th and 5th fingers
7. Elbow Flexion Test
Indication: Cubital tunnel syndrome
Technique: Hyperflexion of the elbow with shoulder flexed at 90°; maintain for 3 minutes. Elbow flexion tightens the cubital tunnel retinaculum and stretches the ulnar nerve.
Positive finding: Reproduction of pain, numbness, or tingling in the ulnar nerve distribution (5th and medial 4th finger)
Technique: Hyperflexion of the elbow with shoulder flexed at 90°; maintain for 3 minutes. Elbow flexion tightens the cubital tunnel retinaculum and stretches the ulnar nerve.
Positive finding: Reproduction of pain, numbness, or tingling in the ulnar nerve distribution (5th and medial 4th finger)
8. Froment's Sign
Indication: Ulnar nerve palsy (specifically tests adductor pollicis, which is ulnar-innervated)
Technique: Ask the patient to hold a piece of paper in a lateral (key) pinch between thumb and radial side of the index finger. Attempt to pull the paper away.
Positive finding: Patient flexes the thumb at the IP joint (using flexor pollicis longus, median-innervated) to compensate for a paralyzed adductor pollicis. IP flexion = positive Froment's sign.
Technique: Ask the patient to hold a piece of paper in a lateral (key) pinch between thumb and radial side of the index finger. Attempt to pull the paper away.
Positive finding: Patient flexes the thumb at the IP joint (using flexor pollicis longus, median-innervated) to compensate for a paralyzed adductor pollicis. IP flexion = positive Froment's sign.
9. Wartenberg's Sign
Indication: Ulnar neuropathy
Technique: Observe the patient's small (5th) finger at rest
Positive finding: Persistent abduction/extension of the small finger during attempted adduction — due to weakness of the 3rd palmar interosseous (ulnar) and unopposed pull of the extensor digiti quinti (radial nerve)
Technique: Observe the patient's small (5th) finger at rest
Positive finding: Persistent abduction/extension of the small finger during attempted adduction — due to weakness of the 3rd palmar interosseous (ulnar) and unopposed pull of the extensor digiti quinti (radial nerve)
10. Jeanne's Sign
Indication: Ulnar neuropathy
Technique: Observe thumb posture during key pinch
Positive finding: Thumb MCP hyperextension during key pinch — due to weak adductor pollicis (ulnar-innervated). Often accompanies Froment's sign.
Technique: Observe thumb posture during key pinch
Positive finding: Thumb MCP hyperextension during key pinch — due to weak adductor pollicis (ulnar-innervated). Often accompanies Froment's sign.
"Froment: thumb IP flexion during key pinch. Jeanne: thumb MCP hyperextension during key pinch. Wartenberg: abduction/extension of small digit during attempted adduction." — Miller's Review of Orthopaedics, 9th Ed.
11. Finger Abduction/Spread Test
Indication: Ulnar intrinsic weakness
Technique: Ask patient to spread fingers apart or cross middle over index finger; resist force pushing them to midline
Positive finding: Weakness confirms ulnar nerve motor branch deficit at or above the wrist level
Technique: Ask patient to spread fingers apart or cross middle over index finger; resist force pushing them to midline
Positive finding: Weakness confirms ulnar nerve motor branch deficit at or above the wrist level
🦾 RADIAL NERVE TESTS
12. Wrist/Finger Extension Test
Indication: Radial nerve palsy or posterior interosseous nerve (PIN) injury
Technique: Place patient's palm flat on a table; ask them to lift each finger straight up (hyperextend MCP joints) against resistance
Positive finding: Inability to hyperextend the finger MCP joints = radial nerve or PIN injury. If the patient can weakly extend the wrist in a radial direction (ECRL/ECRB spared) but not extend fingers → PIN palsy (radial nerve proper is intact)
Classic sign: "Wrist drop" — inability to extend the wrist against gravity
Technique: Place patient's palm flat on a table; ask them to lift each finger straight up (hyperextend MCP joints) against resistance
Positive finding: Inability to hyperextend the finger MCP joints = radial nerve or PIN injury. If the patient can weakly extend the wrist in a radial direction (ECRL/ECRB spared) but not extend fingers → PIN palsy (radial nerve proper is intact)
Classic sign: "Wrist drop" — inability to extend the wrist against gravity
13. Extensor Pollicis Longus (EPL) Test
Indication: Radial nerve / PIN integrity
Technique: Ask patient to extend the thumb against resistance
Positive finding: Weakness or absence = PIN injury (EPL is innervated by the posterior interosseous nerve)
Technique: Ask patient to extend the thumb against resistance
Positive finding: Weakness or absence = PIN injury (EPL is innervated by the posterior interosseous nerve)
MEDIAN NERVE — Proximal Tests
14. Pronator Syndrome Provocative Tests
Indication: Median nerve compression in the proximal forearm (pronator teres level)
Three separate maneuvers isolate the compression site:
Three separate maneuvers isolate the compression site:
| Maneuver | Compression site |
|---|---|
| Resisted elbow flexion with forearm supinated | Bicipital aponeurosis (lacertus fibrosis) |
| Resisted forearm pronation with elbow extended | Between heads of pronator teres |
| Resisted long finger PIP flexion | FDS arch |
Key differentiator from CTS: Pronator syndrome causes sensory disturbances over the thenar eminence (palmar cutaneous branch, exits proximal to carpal tunnel); CTS spares thenar sensation.
🦿 THORACIC OUTLET / LOWER LIMB NERVES
15. Adson Test
Indication: Thoracic outlet syndrome (vascular — subclavian vein/artery compression)
Technique: Patient hyperextends the neck and rotates it to the affected side; decreased radial pulse during inhalation
Positive finding: Diminished or absent radial pulse = positive
Technique: Patient hyperextends the neck and rotates it to the affected side; decreased radial pulse during inhalation
Positive finding: Diminished or absent radial pulse = positive
16. Peroneal Nerve Assessment
Indication: Deep peroneal nerve entrapment (fibular head, anterior tarsal tunnel)
Clinical sign: Foot drop (inability to dorsiflex the foot) + numbness in the web space between the 1st and 2nd toes
Causes: Proximal fibular fracture, habitual leg crossing, prolonged squatting
Clinical sign: Foot drop (inability to dorsiflex the foot) + numbness in the web space between the 1st and 2nd toes
Causes: Proximal fibular fracture, habitual leg crossing, prolonged squatting
Summary Table
| Test | Nerve | Site Tested | Positive Finding |
|---|---|---|---|
| Tinel's sign (wrist) | Median | Carpal tunnel | Tingling in digits 1–3.5 |
| Phalen's test | Median | Carpal tunnel | Tingling in digits 1–3.5 after 60 s wrist flexion |
| Durkan compression test | Median | Carpal tunnel | Tingling in digits 1–3.5 (most sensitive) |
| "OK sign" / AIN test | Median (AIN) | Forearm | Can't form circle — motor loss, no sensory loss |
| Tinel's sign (elbow) | Ulnar | Cubital tunnel | Tingling in digits 4–5 |
| Elbow flexion test | Ulnar | Cubital tunnel | Tingling in digits 4–5 within 3 min |
| Froment's sign | Ulnar | Adductor pollicis | Thumb IP flexion during key pinch |
| Wartenberg's sign | Ulnar | 3rd palmar interosseous | Small finger abduction at rest |
| Jeanne's sign | Ulnar | Adductor pollicis | Thumb MCP hyperextension during key pinch |
| Wrist drop / MCP extension | Radial | Spiral groove / PIN | No wrist/finger extension |
| Adson test | Brachial plexus | Thoracic outlet | Reduced radial pulse |
| Foot drop exam | Deep peroneal | Fibular head | Cannot dorsiflex foot |
Sources:
- Sabiston Textbook of Surgery, 21st Ed. — Table 119.3
- Miller's Review of Orthopaedics, 9th Ed. — Tables 7.8 and Compression Neuropathy section
- Tintinalli's Emergency Medicine, 9th Ed. — Focal Mononeuropathies chapter
- Neuroanatomy Through Clinical Cases, 3rd Ed. — Upper Extremity Nerve Injuries
- Thieme Atlas of Anatomy — General Anatomy and Musculoskeletal System
This is a shared conversation. Sign in to Orris to start your own chat.