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Final Practical Flashcards

1
Q

Grind Test CMC

A

Testing for OA in the thumb

hold patient’s thumb between your thumb and index finger and place your opposite hand over CMC joint. Apply axial compression and rotation to the MC base on trapezium

Positive: painful crepitus and/or instability

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2
Q

OA In the thumb

A

most common in women over 50

due to wear and tear
S/S pain at base of thum and into thenars, weakness in grip, loss of web space, ligament laxity, subluxation/shoulder sign

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3
Q

FDS/FDP Testing

A

FDS: flick into extension, should be flaccid. Holding all fingers down except the one being tested

FDP: needs tension, holding DIP and flicking finger

testing integrity of tendons

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4
Q

Ulnar impingement sign

A

elbow on table, palpate over TFCC, then UD rotate forearm

positive is clicking

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5
Q

Ulnar compression test

A

elbow on table, palpate over TFCC, then UD with axial load, and then rotate forearm

positive is clicking

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6
Q

TFCC Injury

A

wear and tear
FOOSH

TX: avoid WB at first, isometrics, strengthen other forearm rotators, proprioceptive exercises

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7
Q

Treatment of thumb oA

A

orthotics
joint protection
adaptive equipment
thumb stabilization,

strengthening the thumb complex with opposition, holding C position, spinning cap

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8
Q

Watson’s test

A

thumb of one hand in the palmar aspect of scaphoid and the index finger on the radial tubercle dorsally, with wrist in UD

maintianing firm pressure, push hand into RD.

Positive: proximal pole of scaphoid will jump over the radius with a thunk/clunk

testing for scaphoid instability

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9
Q

Scapholunate Ligament Injury

A

FOOSH
pain in rest, pain with weightbearing, decreased grip, popping

TX: dart thrower, wrist proprioception (tennis ball on racket, rain stick.
also orthosis in thumb spica for 3-8 weeks

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10
Q

Froment’s sign

A

as paper is pulled away by the examiner, thumb with injury will go into IP joint flexion

testing adductor pollicis, ulnar nerve compression

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11
Q

Tx for Ulnar Nerve

A

positioning (sleeping, sitting at desk)
orthotics, depends on how far along and where compression is at
nerve gliding
e-stim

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12
Q

Wartenburg’s sign

A

have patient place hand on table, flat. Spread fingers and ask them to bring their fingers back together

positive: pinky is unable to adduct or compensates by bringing other fingers towards pinky

does not tell us where the ulnar nerve is compressed

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13
Q

Elson’s test

A

examiner passively flexes the PIP joint to 90° over the edge of table and asks the patient to attempt active extension of PIP joint while examiner resists PIP joint extension

acute rupture of central slip results in no extension power being felt at the pip joint and significant extension power produced at DIP

testing rupture of central slip

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14
Q

Rupture of the central slip can be a cause for

A

boutinnere deformity

flexion of PIP and extension of DIP

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15
Q

Rupture of central slip MOI

A

hyperflexion

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16
Q

Rupture of central slip Tx

A

acute = immobilize in PIP extension for 6 weeks. Perform oblique retinacular stretches(stretching the DIP joint)
gradual mobilization

contracting contractures with serial casting for chronic

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17
Q

Cozen’s test

A

stabilizing at elbow with forearm in pronation with elbow extended
apply flexion force, patient tries to extend

psotive: pain over lateral epicondyle
testing for lateral epicondylitis

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18
Q

Mill’s test

A

Palpate lateral epicondyle with elbow flexed
passively pronate and flex wrist, then extend elbow

positive: pain over lateral epicondyle, testing for lateral epicondylitis

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19
Q

Tennis Elbow Test

A

support elbow
press down at 3rd digit

positive is pain at lateral epicondyle
testing for tennis elbow

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20
Q

Tennis Elbow

A

MOI: overuse involving eccentric overload at origin of common extensor tendon, usually ECRB

often complain of pain with gripping or decreased grip strength. Point tenderness on lateral epicondyle

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21
Q

Golfer’s Elbow Test

A

palpate medial epicondyle, with elbow flexed, in pronation, with wrist neutral

passively supinate forearm, extend the elbow and wrist

positive = pain over medial epicondyle of humerus

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22
Q

Golfer’s Elbow

A

35 yo and older
overuse

tx: activity modification, soft tissue mobs, isometrics

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23
Q

Varus and Valgus Stress Tests

A

Used as an assessment for LCL and MCL, looking for laxity or pain

Stabilize elbow by holding humerus firmly, and flex elbow to about 5°
place other hand above wrist, abducting and aducting forearm

expect to feel bone to bone

can flex elbow to 25° to test UCL using valgus stress, which would have soft end feel

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24
Q

Moving valgus stress test

A

standing, arm abducted to 100 and elbow flexed fully
create and maintain valgus stress, quickly extend patient’s elbow

reproudction of pain between 120 to 170 indicates positive injury of MCL

HIGH snout and HIGH spin

25
MWMs Tennis Elbow
pts palm down, stabilize humerus with proximal hand, wrist with distal hand lateral glude using strap just distsal to elbow joint and over shoulder nearest to patients head patient performs gripping during mob, wrist extension 10-15 reps at 30, 60, 90 of elbow flexion
26
Humeroradial Dorsal/Volar Glides
Supine, elbow extended and supinated stabilize humerus with hand that is on medial side f pts arm. Place palmar surface of your lateral hand on palmar aspect ad your fingers on dorsal aspect of radial head force: move radial head dorsally with heel of your hand or palmarly with fingers
27
Dorsal glide of radius to increase
elbow extension
28
Palmar glide of radius to increase
elbow flexion
29
Interventions for Lateral Tendinopathy
1. Limit pain provoking activities 2. MWMs 3. Serratus and lower trap exercises, and RC cuff for stability 4. Stretching of forearm extensors 5. Resistance and functional ROM
30
R Nerve Atrophy
Upper post comp lower post comp deep post comp
31
R Nerve Sensory
Ant: lateral upper arm, superior to antebrachial space. Proximal to MCP of thumb Post: forearm, elbow, 1-3 digits excluding DIPs
32
R Nerve Motor
Elbow extension radial deviation wrist extension fist clenching power w/ECRL finger extension thumb abduction, extension supination
33
R Nerve Special Tests
Wrist Drop presentation = would indicate weak extensors supination mmt thumb extension mmt
34
R Nerve Orthoses
Static for acute injuries Functional for late chronic, no possibility of regaining motion on their own Static progressive = beginning to develop contractures Dynamic = protection with movement; proliferative stage
35
R Nerve MOI
spiral groove compression from crutches, alcohol abuse (saturday night palsy), humeral fracture Post interosseous syndrome: repetitive pronation, forearm extension, and wrist flexion
36
R Nerve Treatment
SGC: orthosis, PROM for contractures, AROM once muscle function returns PIS: nerve gliding, positioning, tissue mob
37
R Nerve Clinical Findings
PIS: weakness in wrist and fingers with no sensory impacts but pain at lateral epicondyle. possible wrist drop. Deep pain in post forearm and difficulty making a fist. SCG: weakness/paresthesias throughout, wrist drop
38
R Nerve Entrapment
between supinator heads (arcade of froshe) radial/carpal tunnel spiral groove
39
U Nerve atrophy
medial anterior compartment thumb webbing anterior pinky dorsal hand
40
U Nerve sensory
palmar and dorsal 4-5 digits
41
U Nerve Motor
hand intrinsics, add/abd of digits flexion of 4/5 digits thumb adduction wrist flexion wrist UD
42
U Nerve Special tests
froment's sign claw hand (late) flexed elbow for 20 sec tinel's at hamate or elbow wartenbergs
43
U Nerve Orthoses
Claw hand --> Serial static for contracture correcting, static progressive for increase ROM and motion, functional to then have use of hand again Static --> acute injury, dynamic if motion is needed along with protection
44
U Nerve MOI
Cubital tunnel syndrome: elbows on desk, baseball, javelin Tunnel of Guyon: drills, cycling, arthritis RARE: blood clots, cysts
45
U Nerve Clinical Findings
CTS: pain forearm, numbness in pinky, atrophy of hand, instrinsics, no deep tunnel reflex TOG: numbness/pain in distal ulnar. hand intrinsics of pinky are normal. Worse at night, palmar hand pain, painful wrist extension
46
U Nerve Treatment
Ulnar nerve gliding avoid pressure on guyon's canal sleeping position sitting position possible orthsis
47
U Nerve Entrapment
cubital tunnel ulnar level at wrist (tunnel of guyon)
48
M Nerve Atrophy
anterior compartment, all 3 layers thumb intrinsics
49
M Nerve Sensory
lateral pal palmar digits 1-3, 1/2 4 dorsal DIPs 1-3, 1/2 4
50
M Nerve Motor
thumb flexion and opposition flexion of digits 2-3 wrist flexion wrist RD pronation
51
M Nerve Special Tests
Tinel's Phalen's Reverse Phalen's OK sign
52
M Nerve Orthosis
Static or dynamic --> acute injury Chronic: Serial static for mobilizing, contracture correction Static progressive increase ROM and motion functional to then have use of hand again
53
M Nerve Entrapment
Ligament of struthers lacertus fibrosis between heads of pronator teres at origin of FDS carpal tunnel
54
M Nerve MOI
Pronator Teres Syndrome: repetitive pronation the others are compression at the area
55
M Nerve Carpal Tunnel Syndrome
S/S: worse at night, numbness in fingers, + flick, difficulty with grasp/pinch CF: Thenar atrophy, + tinel at carpal, +phalen/reverse phalen, sensory intact
56
M Nerve Anterior Interosseous Syndrome
S/S difficulty writing, pain in proximal 1/3 of forearm CF: + OK sign, no sensory loss, weakness in fingers 1+2
57
M Nerve Pronator Teres Syndrome
S/S: Pain in hand and fingers CF: No weakness in Pronator Teres and ECRB, + Tinel's at proximal forearm, sensory loss
58
M Nerve Lacertus Fibrosis
S/S: pain in median n distribution, deep pain at ligament of struthers (lateral upper arm near elbow) CF: weakness in all median muscles, benediction's hand, + Tinel at distal humerus

5 Ortho (14 decks)

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