Hand Flashcards

Question

Active insufficiency

Answer 1

Muscles can only contract ½ the length of the muscle body. This never increases so if the tendon has been stretched, the muscle will contract and there will be “slack” in the over stretched tendon, so we feel trace but there is no movement. No amount of strengthening will help. Splinting in neutral or slight extension for 3-4 weeks (maybe longer) with active extension and slight flexion (10-15 degrees) ONE day out of the splint, you start ALL OVER!! Prime mover Insufficiency in concentric contraction

Answer 2

If the client stays in this position, or is unable to actively extend, the flexors will shrink and then prevent extension. If you can’t get full passive extension, they most likely have passive insufficiency of the flexors. Insufficiency in eccentric contraction. Antagonist muscle

Answer 3

Tenodesis action C6 spinal cord injury - Extension of wrist actively * Natural passive insufficiency of the finger flexors - Flexion by way of gravity * Natural passive insufficiency of the finger extenders - We want it to get worse (slight contracture) * Never stretch wrist extensors and digit extensors together or finger and wrist flexors together

Answer 4

Expected = 60-80º End feel = firm Position 1. Ulnar side - Seated with arm hanging off table - Stationary arm: midline of ulnar - Axis: over the triquetrum - Movable arm: midline of fifth metacarpal 2. Radial side - Seated with arm resting on ulnar boarder - Stationary arm: midline of the radius - Axis: over the radial styloid - Movable arm: midline of 2nd metacarpal 3. Over the top - Stationary arm: midshaft of forearm - Axis: over the capitate - Moveable arm: third metacarpal

Answer 5

Expected = 60-70º End feel = firm Position 1. Ulnar side, exactly the same, flip goniometer over 2. Radial Side, exactly the same, flip goniometer over 3. Up from the bottom Stationary arm: on the palmer surface, mid line Axis: palmer surface under the capitate Moveable arm: on the palm with third metacarpal

Answer 6

Expected = Radial - 20º, Ulnar - 30º End feel = hard for radial, firm for ulnar Position (same, just flip it) - Hand flat on table - Stationary arm: midline of forearm - Axis: dorsal wrist over the capitate - Moveable arm: midline of third metacarpal (NOT phalanx!!) Possible substitution - Flex wrist

Answer 7

Expected = 90-100º (90º is most common) End feel = hard Position - Stabilize the wrist, can do it in sidelying or on elbow (“aim for the imaginary line”) - Stationary Arm: dorsal midline of corresponding metacarpal - Axis: dorsal aspect of MCP joint - Moveable arm: midline of proximal phalanx

Answer 8

Expected = 0 is the neutral position with 20-45º of extension or hyperextension (20 is most common) End feel = firm Position - Same as flexion except you have to use a full circle goniometer or measure from the palmer surface - Stabilize the wrist, can do it in sidelying or on elbow (“aim for the imaginary line”) - Stationary Arm: dorsal midline of corresponding metacarpal - Axis: dorsal aspect of MCP joint - Moveable arm: midline of proximal phalanx

Answer 9

No norm with this one, typically 10-20º, compare to adjacent digits and other hand End feel = loose in extension, firm in flexion Position - Hand flat on table - Stationary arm: midline of metacarpal - Axis: over the MCP joint - Moveable arm: over the proximal phalanx

Answer 10

Expected = 100-110º End feel = firm Position - Joint blocking is often required - Cut off goniometer works well - Sidelying or up on elbow - Block MP and ask them to flex (aim for the “fat pads”) - Stationary arm: midline of proximal phalanx - Axis: over the PIP joint - Moveable arm: midline of middle phalanx

Answer 11

Expected = 0º, however, 10º hyperextension is normal if all are like that End feel = firm Position: same as flexion, but from the palmer surface - Stationary arm: midline of proximal phalanx - Axis: over the PIP joint - Moveable arm: midline of middle phalanx

Answer 12

Expected = 70-90º End feel = firm Position: same as PIP, but move a phalanx - Will need to joint block - Can measure with PIP if they can isolate - “Touch the fat pad” - Stationary arm: midline of proximal phalanx - Axis: over the PIP joint - Moveable arm: midline of middle phalanx

Answer 13

Expected = 0º - up to 10º hyperextension is expectable if all others have it Position: same as PIP, but move a phalanx - Will need to joint block - Can measure with PIP if they can isolate - “Touch the fat pad” - Stationary arm: midline of proximal phalanx - Axis: over the PIP joint - Moveable arm: midline of middle phalanx

Answer 14

Flexion (across the palm) Expected = 15º End feel = soft Position - Hand is positioned FLAT with the thumb aligned with index finger - This means you may not start at 0 - Stationary arm: palmer surface, along the radial shaft - Axis: over CMC joint - Moving Arm: along the shaft of the first metacarpal (don’t follow the IP!!)

Answer 15

Expected = 0-20º of motion (you may see larger numbers, up to 70º) Position - Hand is positioned FLAT with the thumb aligned with index finger - This means you may not start at 0 - Stationary arm: palmer surface, along the radial shaft - Axis: over CMC joint - Moving Arm: along the shaft of the first metacarpal (don’t follow the IP!!)

Answer 16

Expected = 30-70º Also called palmer abduction Position: - Hand in sidelying with radial side up - Axis: lateral aspect of radial styloid - Stationary arm: midline of 2nd metacarpal - Moveable arm: midline of 1st metacarpal NOTE START POSITION!!!!!!!!!!

Answer 17

Only measured if unable to do it Common with CMC replacements Should be able to come in to 0º, if not record the lack of motion in negative -10º adduction

Answer 18

Occurs due to the CMC, MP and IP joint Primarily the CMC Several ways to measure To tip of small or 5th digit To base of small or 5th digit Can use a tape or ruler to measure distance off palm

Answer 19

Expected= 50-60º (flexion), 0-10º hyperextension (extension) Position: - Hand in sidelying - Axis: dorsal aspect of MP - Stationary arm: dorsal midline of metacarpal - Moveable arm: dorsal midline of proximal phalanx Extension is measured in negative

Answer 20

Expected = 80º flexion Position - In sidelying - Axis: over the dorsal IP joint - Stationary arm: over midline of dorsal proximal phalanx - Moveable arm: over midline of dorsal distal phalanx Expected = 0º extension - Measured just like MP

Answer 21

Typically when looking at the wrist and digits, we do not do full MMT. MMT are commonly done on the wrist Typically use a dynamometer to get grip strength for digits

Answer 22

Position - Forearm in supination AG or sidelying GM Palpation: flexor wad or over tendon at the wrist Resistance: into palm of hand Check each flexor

Answer 23

Position: - Hand in prone AG and sidelying for GM Palpation: at extensor wad or over the wrist Resistance: over dorsal metacarpals

Hand Flashcards

(47 cards)