cervical to philanges ortho exam (includes wrist/hand special tests and clnical signficiance things) Flashcards Preview

PHTH 7232 Ortho > cervical to philanges ortho exam (includes wrist/hand special tests and clnical signficiance things) > Flashcards

Flashcards in cervical to philanges ortho exam (includes wrist/hand special tests and clnical signficiance things) Deck (44):
1

Cervical Soft Tissue Palpations (7)

  • SCM
  • Upper Traps
  • Middle Traps
  • Levator Scap
  • Rhomboids (on neck)
  • Paraspinals & Extensors (occiput to T3)
  • Suboccipitals

2

Clinical Significance: Upper traps

Common to have dysfunction here for neck pain pts

Associated with forward head posture
Can get trigger points easily

3

Clinical Significance: suboccipitals

can become really tight with a forward head posture

When tight they trigger head aches

They can be tender so it is good to palpate

4

Movements of SCM (2)

Contralateral rotation

Ipsilateral flexion

5

Most muscles, what to palpate for

defects and tenderness

Pain, tenderness, trigger points

6

Rhomboid major attachments

  • Spinous processes of T2-T5
  • Lateral scapular spine to inferior angle

7

Rhomboid Major/Minor (Attachments)

Medial border of scapula to cervical and

upper thoracic spinous processes (C7-T5)

8

Normative ROM for C-spine

Flex: 50

Ext: 60

Lat Flex: 45

Rotation: 80

9

C-Spine goiniometry: Saggital plane

Flexion 50 degrees

Extension 60 degrees

10

C-Spine goiniometry: Frontal plane

Lateral flexion: 45 degrees

11

C-Spine goiniometry: Transverse

Rotation 80 degrees each way

12

Three Cervical Manual Muscle Tests

Combined Flexion

Combined Extension

Rotation (primarily tests SCM)

13

VEOS

Valgus Extension Overload Syndrome.

compression stress on radial side of elbow, distraction stress on medial side. Overhead extension movements - overhead athletes

14

OCD

Osteocondritis Dessicans

15

Valgus extension overload syndrome (elbow)

a circular effect with tensile stress along the medial restraint, shear stress in the posterior compartment and compression stress laterally

Can result in UCL tear OCDs etc

16

cyriax muscle-tendon unit tests

  • AROM: painful
  • Resisted at midrange: more painful
  • PROM: extension painful (but doesn't have to be as much)

17

Elbow Special non-neuro Test types (4 types)

  1. Cyriax Tests
  2. Valgus & Varus (0, 30)
  3. Milking Tests (test for VEOS)
  4. Radiocapitular Compression Test (check for crepitus, clunking, grating, pain ----- indicates OCDs at joint).

18

Special Tests Elbow, Neural

  1. Tinel's Sign (median, ulnar, radial n.) - looking for replication of symptoms
  2. Pronator Teres Syndrome Test - entrapment of Anterior Interosseous nerve - perform 3 times

19

Cyriax Tests for the elbow (2)

Cyriax Tests      

  • Wrist flexors      
  • Wrist extensors

20

Valgus/Varus tests for elbow

Valgus & Varus (0, 30)      

  • 0 degrees      
  • 30 degrees

21

Milking Tests

Milking Tests (test for VEOS)      

  • Milking Test (120 degrees)      
  • Modified (70 degrees)      
  • Dynamic (120 - 70 degrees)

22

Radiocapitular Compression Test

Radiocapitular Compression Test  

  • axial load with RD, palpate radial head  
  • Add Pronation 3 times  
  • Add Supination 3 times  

DDD Version      

  • go 90-extension in Pronation      
  • go 90-extension in Supination

23

The UCL tests and the radiocapitular tests are all designed to check for _________.

VEOS (Valgus Extension Overload Syndrome)

24

All Elbow Special Tests (6)

  1. Cyriax
  2. Valgus/Varus
  3. Milking
  4. Radiocapitular Compression 5. Tinel's Sign
  5. Pronator Teres Syndrome Test

 

 

25

Boxer's fracture

fourth or fifth metacarpal fracture because there is more mobility in those metacarpals

26

palpate CMC joints, common problem here

arthritis will often cause pain here

27

Philanges palpation

  • PIP (pain instability)
  • DIP (pain, mobility)
  • Bouchard's nodes
  • Heberden's Nodes

28

Bouchard's Nodes

Enlargement at PIP from RA

29

Heberden's nodes

enlargement at DIP from osteoarthritis

30

feel for ____ in palmar facia

nodules

31

tufts of fingers

part of observation/palpation

32

Finger & thumb Special Tests: Stability (4)

  1. Axial Load (finger/thumb)
  2. Grind Test (thumb)
  3. Thumb UCL (0, slight flexion)
  4. Collateral Ligaments of Fingers

33

Finger/Thumb Special Tests, Musculotendinous: (3)

1. Finkelstein Test - 1st tunnel

2. Sweater/Jersey Finger - Flexor Digitorum profundus

3. Mallet Finger - Extensor Digitorum Communis

34

Hand Special Tests, Circulation: (2)

  1. Allen's Test - compress radial and ulnar arteries at wrist while flexing hand 10 times, let one go, observe refill. Repeat but let other one go.
  2. Digital Bloodflow (same as capillary refill)

35

Hand neurological Special tests: (6)

  1. Tinnel's (carpal tun - median; Guyon's tun - ulnar)
  2. Phalen's (reverse prayer - median)
  3. Froment's Sign (paper pinch - ulnar nerve, AdP)
  4. OK Sign (median - FPL & FDP)
  5. Semmes Weinstein (filament)
  6. Weber's two point discrimination test (paperclip)

36

Three best tests for Carpal Tunnel

1. Tinel

2. Phalen

3. Semmes Weinstein

37

Weber's Two point discrimination Test norm

6mm

Do on nerve distribution

38

Deformity in swan neck deformity?

flexion MCP and DIP,

extension of PIP

39

Boutonniere deformity is a?

finger joint deformity -PIP flexion with DIP hyperextension

from RA

40

Murphy's sign

dislocation of the lunate. make a fist; veiw knuckles.

As the examiner, visually inspect the dorsal aspect of the hand. Normally the knuckle formed by the head of the third metacarpal is more prominent and protrudes further distally as compared to the knuckles of the second and fourth metacarpal heads. If the knuckle of the third metacarpal head is level with the knuckles of the second and fourth metacarpal heads, the sign is positive and indicative of a lunate dislocation.

41

Clinical significance of tunnel one (2):

1. senosing tenosynovitis

2. DeQuervain's Syndrome

42

Clincal Significance of Tunnel 4

If pt has RA, tendons can develop cysts and rupture.

Tendons are Extensor Digitorum Communis and Extensor Indicis

43

Clinical significance of tunnel 6

this tendon commonly ruptures if there is a colles fracture

(extensor carpi ulnaris is in this tunnel)

44

Wrist Special Tests (4)

  1. Lunotriquetrum Ballottement test
  2. Murphey's Sign - fist with 3rd dropped
  3. Watson's Test, (scaphoid fracture) palpate scaphoid and PROM flex and RD - ext and UD
  4. Scaphoid Stress Test - (scaphoid fracture) palpate scaphoid and AROM flex and RD - ext andUD