- Tenderness with passive stretch of flexor muscles is related to ischemia. This tenderness may be a result of trauma to the hand or wrist.
- 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
- 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.
- Passively extend the patient’s fingers of the affected hand.
- Determine how this extension influences the tenderness and pain s/he usually experiences.
- Check for intracompartmental swelling or external compression, which may be signs of compartment syndrome.4
- Examine the contralateral wrist and hand.
- 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
- 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