Elbow, Wrist, and Hand Dx/Tx MET/ART

Question 1

What is the normal carrying angle for males and females?

Answer 1

5 degrees for males

10-15 degrees for females

Question 2

What is the ranges of motion for the elbow? (2 extra than we usually do)

Answer 2

Flexion - 140-150
Extension = 0 to -5
Supination = 90
Pronation = 90
Ulnohumeral Adduction = 5
Ulnohumeral Abduction = 5

Question 3

What is Elbow Extension SD MET/ART?

Answer 3

Patient is Seated

physician places elbow into flexion barrier (since extension is what they like to do).

The patient gently tries to extend against resistance. 3-5 seconds

Repeat steps three to 5 times

Question 4

What is Elbow Flexion SD? MET/ART

Answer 4

physician places the elbow into extension barrier (since they like to flex). The person then flexes against resistance for 3-5 seconds, 3-5 times or until SD is alleviated

Question 5

What is Elbow Adduction SD MET/ART?

Answer 5

The patient likes to adduct. So you put them into abduction and have them gently adduct the elbow against an unyielding counterforce. You do this 3-5 times for 3-5 seconds each

Question 6

What is Elbow Abduction SD MET/ART?

Answer 6

The patient likes to go into abduction so you put them into their adduction barrier and have them ABDUCT against an unyielding counterforce. You do this 3-5 times for 3-5 seconds each.

Question 7

What is Anterior Radial Head SD?

Answer 7

Patient is seated, physician stands up facing the patient.

physician grasps the patients hand on the side of the dysfunction, contacting the dorsal aspect of the distal radius radius with the thumb.

physician’s other hand is palm up with the thumb resting against the anterior and medial aspect of the radial head

the physician pronates the patient’s forearm to the edge of the restrictive barrier. The physician instructs the patient to ATTEMPT TO SUPINATE while the physician applies an unyielding counterforce.

this isometric contraction held for 3-5 seconds and then they relax.

physician sticks the pronation into the new restrictive barrier while exaggerating the posterior rotation of the radial head with the left hand (one on the elbow side).

Question 8

What is Posterior Radial Head SD?

Answer 8

patient is seated, physician stands in front

physician grabs patients hand on the side of the dysfunction (handshake position), contacting palmar aspect of the distal radius with the index finger.

Physicians other hand is palm up with the thumb resting against the posterolateral aspect of the radial head. (under the arm)

physician supinates the patients forearm until restriction barrier. patient then ATTEMPTS TO PRONATE

held for 3-5 seconds, then go to new barrier (assessing and exaggerating the anterior rotation of the radial hand with the other hand). repeat as necessary

Question 9

What is a Wrist flexion SD for the wrist and carpal bones

Answer 9

you prefer to go into flexion, restriction to extension

You prefer a posterior glide of your carpal bones

Question 10

What is a wrist extension SD for the wrist and carpal bones?

Answer 10

you like to go into extension, so your wrist prefers extension, restriction to flexion

carpal bones prefer to go in an anterior glide.

Question 11

What is Wrist abduction SD?

Answer 11

prefers abduction, restricted to adduction

Question 12

What is wrist adduction SD?

Answer 12

prefers adduction, restricted to abduction

Question 13

What is MCP abduction (gross motion al all digits)?

Answer 13

it means that you move away from the long finger longitudinal axis. so you have freedom to moving away, you struggle to go back to normal

Question 14

What is MCP adduction?

Answer 14

you can adduct your fingers, but you can’t abduct your fingers that well. that’s where the restriction is.

Question 15

What is thumb abduction?

Answer 15

freedom of motion to abduction of the thumb, restricted to adduction

Question 16

What is radiocarpal flexion SD?

Answer 16

patient seated with the physician standing facing the patient

physician extends the patient’s wrist to the edge of the restrictive barrier. (extension)

the physician tells them to flex the wrist while the physician applies an unyielding counterforce.

repeat with the new barrier

reassess

Question 17

what is radiocarpal extension SD?

Answer 17

physician flexes the wrist to restriction barrier. They then extend against it for 3-5 seconds.

go to the new barrier and do it again until it stops moving (3-5 times).

reassess

Question 18

What is Radiocarpal Adduction SD?

Answer 18

physician abducts the patient’s wrist (radial deviation) to the edge of the restriction barrier. The person then goes against the resistance and tries to abduct.

physician then goes to a new barrier and has them do it 3-5 times 3-5 seconds each time until there is no new barrier.

reassess

Question 19

What is Radiocarpal Abduction SD?

Answer 19

physician adducts the patient’s wrist (ulnar deviation) to the edge of the restrictive barrier.

the patient tries to abduct the wrist (since they like going that way) against an unyielding counterforce.

You then repeat this 3-5 times with new barriers for 3-5 seconds until there is no more movement.

reassess

Question 20

What is Flexor Retinacula MFR?

Answer 20

This is this same thing as Still’s Wrist MFR.

the operator interlaces the fingers of both hands applying a thenar eminence contact across the distal radius and ulnar on the dorsal side and wrist retinaculum on palmar side.

maintain anteroposterior compression over the wrist while the patient actively flexes and extends the fingers.

Patient repeats flexion and extension efforts several times, mobilizing flexor tendons under the flexor retinaculum while the operator’s hands maintain compression resulting in distraction.

reassess

Question 21

What is Wrist Isotonic MET?

Answer 21

Physician crosses thumbs and contacts the tissue over the patient’s pisiform and trapezium

while the pt tries to flex the wrist, the doctor applies pressure with both thumbs in a lateral direction

physician lightens force slowly to allow patient to OVERCOME the physician’s force.

repeat until dysfunction is alleviated

Question 22

Figure 8 Wrist Articulation?

Answer 22

Place the patients wrist between the wrists of the operator (perpendicularly)

move the wrist in a figure 8 motion repetitively until SD is alleviated

Question 23

What is Metacarpophalangeal Joint SD - ART?

Answer 23

Physician evaluates the motion at the metacarpophalangeal joint in flexion, extension, abduction, adduction, clockwise and counterclockwise circumduction

when you feel a restriction, gentle repetitive motion is made THROUGH THE BARRIER towards the anatomic barrier

continue articulation until SD is alleviated

Question 24

What is Proximal and Distal Interphalangeal Joint SD - ART?

Answer 24

Physician evaluates the motion at the proximal and distal interphalangeal joints in flexion, extension, abduction, adduction, clockwise and counterclockwise circumduction.

when a restriction is felt, gentle repetitive motion is made THROUGH THE BARRIER toward the anatomic barrier.

continue articulation until SD is alleviated