Hand Surgery Source

Passive Stretch Test

Test, Exam and Signs

Description

  • Tenderness with passive stretch of flexor muscles is related to ischemia. This tenderness may be a result of trauma to the hand or wrist.  

Pathophysiology

  • The passive stretch test can help to diagnose Colles’ fracture, scaphoid fractures, distal radius growth plate fracture and compartment syndrome.1
  • Colles’ fracture and scaphoid fractures may be caused by a fall on the outstretched hand (FOOSH).2
  • If the patient experiences tenderness and/or pain with passive stretch at the metacarpophalangeal (MP) joint, this may indicate compartment syndrome of the hand.3
  • Untreated compartment syndrome may lead to Volkmann’s ischemic contracture, which involves nerve dysfunction in the affected compartment.4

Instructions

  1. Obtain an accurate and complete patient history. Ask the patient to rate on a scale from 1-10 how much pain s/he usually experiences in the affected hand and/or wrist.
  2. Passively extend the patient’s fingers of the affected hand.
  3. Determine how this extension influences the tenderness and pain s/he usually experiences.
  4. Check for intracompartmental swelling or external compression, which may be signs of compartment syndrome.4
  5. Examine the contralateral wrist and hand.

Variations

  • Avoid using other patients’ reactions as a comparison, because other patients may have different perceptions of similar tenderness and/or pain.
  • Also check for a tense muscle compartment and restricted active motion.  These symptoms may indicate compartment syndrome.2

Related Signs and Tests

  • Fracture crepitus
  • Allen test2
  • Neurovascular exam
  • Interstitial tissue pressure measurement4
  • Radiographs
  • CT scan

Diagnostic Performance Characteristics

  • To improve the reliability in diagnosing fractures, use radiographs or CT scans.
  • Use an intracompartmental pressure threshold of 50 mmHg to verify the diagnosis of compartment syndrome.3
Presentation Photos and Related Diagrams
  • Passive extension of fingers creates stretching of the left flexor muscles (double arrow). If the muscle is ischemic stretching causes severe pain. Pain in area of distal radius fracture (single arrow) is related to fracture tenderness not ischemia secondary to compartment syndrome.
    Passive extension of fingers creates stretching of the left flexor muscles (double arrow). If the muscle is ischemic stretching causes severe pain. Pain in area of distal radius fracture (single arrow) is related to fracture tenderness not ischemia secondary to compartment syndrome.
  • Passive extension of fingers creates stretching of the right flexor muscles. If the muscle is ischemic stretching causes severe pain. Pain in area of distal radius fracture (single arrow) is related to fracture tenderness not ischemia secondary to compartment syndrome.
    Passive extension of fingers creates stretching of the right flexor muscles. If the muscle is ischemic stretching causes severe pain. Pain in area of distal radius fracture (single arrow) is related to fracture tenderness not ischemia secondary to compartment syndrome.
Definition of Positive Result
  • A positive result occurs when passive stretch of ischemic flexor muscles causes extreme tenderness and/or pain.
Definition of Negative Result
  • A negative result occurs when passive stretch of flexor muscles does not cause extreme tenderness and/or pain.
Comments and Pearls
  • Pain caused by passive finger extension that out of portion to the injury and is not locally primarily to the injury site is the major sign of compartment syndrome.
  • for example, pain in the area of a distal radius fracture is related to fracture tenderness and not ischemia.
  • When examining children with fractures, be vigilant for growth plate injuries. Unrecognized injuries could result in a stop or delay in growth.5
Diagnoses Associated with Tests, Exams and Signs
References
  1. Culp R, Jacoby S. Musculoskeletal Examination of the Elbow, Wrist and Hand: Making the Complex Simple. New Jersey: SLACK Incorporated, 2012.
  2. Rayan G, Akelman E. The Hand: Anatomy, Examination and Diagnosis. Philadelphia: Lippincott Williams & Wilkins, 2012.
  3. Codding JL, Vosbikian MM, Ilyas AM. Acute compartment syndrome of the hand. J Hand Surg Am 2015;40(6):1213-6. PMID: 25801580
  4. Leversedge FJ, Moore TJ, Peterson BC, Seiler JG 3rd. Compartment syndrome of the upper extremity. J Hand Surg Am 2011;36:544-59. PMID: 21371631
  5. Arora R, Fichadia U, Hartwig E, Kannikeswaran N. Pediatric upper-extremity fractures. Pediatr Ann 2014;43(5):196-204. PMID: 24877490
  6. Eaton RG Green WT: Volkmann's ischemia: A volar compartment syndrome of the forearm. Clin Orthop Rel Res 113:58, 1975
  7. Gelberman RH, Garfin SR, Hergenroeder PT, Mubarak SJ, Menon J.  Compartment  syndromes of the forearm: diagnosis and treatment.  Clin Orthop Relat Res 1981;161:252–261.