Hand Pain Wk 5

Question 1

C5 Nerve Root

Answer 1

Disc level: C4
Muscle test: 
   deltoid, axillary nerve
   biceps, musculocutaneous nerve
Reflex: Biceps
Sensation: lateral arm

Question 2

C6 Nerve Root

Answer 2

Disc Level: C5
Muscle Test:
wrist extension (flexor carpi radialis longus and brevis and extensor carpi ulnaris, radial nerve)
Reflex: brachioradialis
Sensation: lateral forearm thumb and index fingers

Question 3

C7 Nerve Root

Answer 3

Disc level: C6
Muscle test:
-elbow extension (triceps, radial nerve)
- wrist flexion (flexor carpi radialis, median nerve and flexor carpi ulnaris, ulnar nerve)
-finger extension (extensor digitorum communis, extensor indicis profundus, extensor digiti minimi, radial nerve)
Reflex: Triceps
Sensation: palm and middle finger

Question 4

C8 Nerve Root

Answer 4

Disc level: C7
Muscle Test:
    finger flexion (flexor digitorum superficialis, flexor digitorum profundus, lumbricals, median and ulnar nerves)
Reflex: NONE
Sensation:  4th 5th digits

Question 5

T1 Nerve Root

Answer 5

Disc Level: T1
Muscle tests:
-finger abduction (dorsal interossei, ulnar nerve)
-finger adduction (palmar interossei, ulnar nerve)
Reflex: NONE
Sensation: medial elbow

Question 6

Bony Palpation of Cervical Spine

Answer 6

Anterior
    hyoid bone
    thyroid cartilage
    first cricoid ring
    mandible
Posterior
    occiput
    Inion (EOP)
    superior nuchal line
    mastoid process
    spinous processes
    facet joints

Question 7

Cervical Soft Tissue Palpation

Answer 7

SCM
anterior lymph chain
posterior lymph chain
thyroid gland
carotid pulse
supraclavicular fossa
traps
greater occipital nerves
superior nuchal ligament

Question 8

Cervical Spine ROM

Answer 8

flexion 50
extension 60
lateral flexion 45
rotation 80

Question 9

Foraminal Compression Test

Answer 9

seated and standing behind. clasp hands over head and exert gradual downward pressure. do straight, left, right

-exacerbation of localized cervical pain indicates foraminal encroachment or facet pathology without nerve root compression. exacerbation of cervical pain with a radicular component indicates foraminal encroachment or facet pathology with nerve root compression

Question 10

Cervical Distraction Test

Answer 10

seated. grasp hands and exert upward pressure
- diminished or absence of pain indicates foraminal encroachment (local pain diminishes), nerve root compression (radicular pain diminishes) or cervical pain increases indicating muscular strain, ligamentous sprain, myospasm, facet capsulitis

Question 11

Spinal Percussion Test

Answer 11

seated with slight head flexion. percuss each spinous and the associated musculature with hammer

-local pain indicating possible fractured vertebrae, ligamentous involvement (spinous pain), and muscular involvement (muscular pain) or radiating pain indicating possible disc pathology

Question 12

Shoulder Depression Test

Answer 12

seated. stabilize and laterally flex head, push down on shoulder
- localized pain on the side being testing indicates dural sleeve adhesion, muscular adhesion or contracture, spasm, or ligamentous injury. radiating pain on the side being tested indicates neurovascular bundle compression, dural sleeve adhesions or TOS. Radicular pain opposite side being tested indicates foraminal encroachment with nerve root compression

Question 13

Valsalva

Answer 13

bear down as if having bowel movement

-radiating pain from the site of lesion (usually recreating the complaint in cervical or lumbar area of the spine) indicates space occupying lesion

Question 14

Swallowing test

Answer 14

watch them swallow

-difficulty swallowing indicates space occupying lesion at anterior portion of cervical spine, possibly esophageal or pharyngeal injury, anterior disc defect, muscle spasm, or osteophytes.

Question 15

Soto-Hall

Answer 15

• supine, flex head toward chest while exerting downward pressure on patients sternum with knife edge
• generalized pain in cervical region, which may extend down to T2 indicates non specific test for structural integrity of cervical region

Question 16

Kernig Sign

Answer 16

supine. flex hip and knee to 90d. then slowly extend leg

- inability to fully extend leg and/or pain (usually in the neck region) indicates meningeal irritation/ meningitis.

Question 17

O-Donoghue Maneuver

Answer 17

seated. passive ROM. Then each ROM against resistance.

- pain during passive ROM indicates ligamentous sprain, pain during resisted ROM indicates muscle/tendo strain

Question 18

L’Hermittie Sign

Answer 18

sitting or supine. flexes the head toward chest or doctor actively flexes patients head to chest

-electric shock-like sensations down the spine and/or through extremities indication dural irritation, severe spinal cord injury or degeneration

Question 19

Brudzinski Sign

Answer 19

supine, flex patients head to chest

-involuntary knee flexion indicates meningeal irritation or nerve root lesion

Question 20

Jackson Compression

Answer 20

seated, dr standing behind. laterally flex head and then exert downward pressure, each side

-exacerbation of localized cervical pain indicates foraminal encroachment without nerve root pressure or facet pathology. exacerbation of cervical pain with radicular component indicates foraminal encroachment with nerve root compression

Question 21

Maximal Cervical Compression

Answer 21

pt seated, dr standing behind. tell the patient to rotate the head and hyperextend the neck

-pain on concave side indicates foraminal encroachment. if radicular component present consider nerve root compression

Question 22

Bakody Sign aka

Answer 22

aka shoulder abduction test
seated, tell pt to place the palm of affected side flat on top of head

-decrease or absence of radiating pain indicates cervical foraminal compression, nerve root entrapment

Question 23

Bony Palpation of Elbow

Answer 23

medial epicondyle
medial supracondylar line of humerus
groove of ulnar nerve
trochlea
olecranon
olecranon fossa
lateral epicondyle
lateral supracondylar line of humerus
radial head

Question 24

Soft Tissue Palpation of Elbow

Answer 24

ulnar nerve
wrist flexor muscles
    pronator teres
    flexor carpi radialis
    palmaris longus
    flexor carpi ulnaris
medial collateral ligament
supracondylar lymph nodes
brachial artery
triceps muscle
lateral collateral ligament
Biceps muscle
olecranon bursa
elbow flexor muscles
      brachioradialis
      extensor carpi radialis longus
      extensor carpi radialis brevis

Question 25

Elbow ROM

Answer 25

flexion 150 extension 0 supination/pronation 80

Question 26

Medial/ Lateral colllateral ligament test akas

Answer 26

aka abduction/adduction stress -excessive gapping and/or pain indicates medial/latreal collateral ligament instability

Question 27

Tinel Elbow Sign

Answer 27

with hammer, tap ulnar groove -pain and/or tenderness at the site being tapped and paresthesia in the ulnar nerve distribution area fingers 4,5 indicates neuroma of ulnar nerve

Question 28

Cozen Test

Answer 28

pt makes fist and wrist extension. resists as flexion stress is applied -pain over lateral epicondyle indicates lateral epicondylitis aka tennis elbow

Question 29

Mills Test

Answer 29

pt seated at edge of table rest with fingers, wrist, and elbow flexed, forearm supinated. with smooth continuous motion thru internal rotation. -pain over lateral epicondyle indicates lateral epicondylitis or tennis elbow

Question 30

Golfer Elbow Test

Answer 30

arm extended, fist up toward face. try to pull down, pt restists -pain over medial epicondyle indicates medial epicondylitis

Question 31

Bony Palpation of Wrist

Answer 31

``` radial styloid process scaphoid lunate listers tubercle triquetrium pisiform trapezium trapezoid capitate hook of hamate ulnar styloid process metacarpals phalanges ```

Question 32

Soft tissue palpation of Wrist

Answer 32

``` ulnar artery radial artery palmaris longus tendon carpal tunnel region thenar eminence hypothenar eminence palmar aponeurosis tissues surrounding proximal and distal interphalangeal joints distal tufts ```

Question 33

ROM of wrist and hand

Answer 33

wrist flexion 80 wrist extension 70 ulnar deviation 30 radial deviation 20 finger abduction, adduction, flexion, extension thumb flexion, extension, opposition, adduction, abduction

Question 34

Tinel Wrist

Answer 34

wrist supinated. tap over palmar surface -reproduction of pain, tenderness and/or parasthesia in the medan nerve distribution area (thumb, 2, 3 and lateral 4th) indicates median neuritis, possibly carpal tunnel syndrome

Question 35

Phalen, Reverse Phalen, Prayer

Answer 35

holds for 60 sec or until pain -reproduction of pain and/or parasthesia in the median nerve distribution area (digits 1,2,3 and lateral 4) indicates median neuritis possibly carpal tunnel syndrome

Question 36

Finkelstein Test

Answer 36

thumb in, make fist, tip down -pain distal to radial styloid indicates stenosing tenosynovitis of the abductor pollicis longus and extensor pollicis brevis tendons aka DeQuervains disease

Question 37

Bunnel- Littler Test

Answer 37

with metacarpophalangeal joint in extension, try and flex proximal joint. if no, then place in flexion and try again -flexion of the proximal interphalangeal joint cannot be achieved indicates joint capsule contracture. Flexion of proximal interphalangeal joint is achieved indicates tight intrinsic muscles

Question 38

Retinacular Test

Answer 38

same as Bunnel- Littler -flexion of distal joint cannot be achieved indicates joint capsule contracture. flexion of distal joint is achieved than tight retinacular ligament

Question 39

Allen Test

Answer 39

one hand above head, other palm up on leg. and make fists for 60 secs. Occlude radial and ulnar arteries, lower, open one, check color. do again, open the other artery. -a delay of more than 10 secs in returning of reddish color to the hand indicates radial or ulnar artery insufficiency. The artery held is not the artery being tested.

Question 40

Lymph nodes of head and neck

Answer 40

checking for size, shape, consistency, mobility, and condition ``` occipital postauricular preauricular tonsilar submandibular submental facial anterior cervical chain posterior cervical chain supraclavicular ```

Question 41

Roos Test aka?

Answer 41

aka Elevated arm stress test seated. bring arms and elbows to 90. open and close fists rapidly up to 3 min -ischemic pain, heaviness of arms, or numbness and tingling of hand indicates thoracic outlet syndrome on side involved

Question 42

Adsons Test aka?

Answer 42

aka scalene maneuver and scalenus anticus test seated. establish radial pulse. then bring arm straight and back past body. tell patient to look up(brings scalenes over neurovascular bundle) then rotate to currently tested shoulder. then take breath and hold. then turn and look to other side. -pain and/or parathesia, decreased or absent radial pulse, pallor indicates compression of neurovascular bundle by scalenus anticus or cervical rib

Question 43

Halstead Maneuver

Answer 43

seated. find radial pulse. traction arm downward. have patient look up. deep breath. turn and look away from me - pain and/or parasthesia, decreased or absent pulse, pallor indicates compression of the neurovascular bundle by scalenus anterior or cervical rib

Question 44

Eden aka?

Answer 44

aka Costoclavicular manuever seated. establish radial pulse. tell patient to sit up, shoulders back, chest out, touch chin to chest and hold breath -pain and/or parathesia, decreased or absent pulse, pallor indicates compression of the neurovascular bundle between the clavicle and first rib

Question 45

Hyperabduction maneuver aka?

Answer 45

aka Wright Test establish radial pulse and slowly hyperabduct the arm -pain and/or parathesia, decreased or absent pulse, pallor indicates compression of the axillary artery by pectoralis minor or coracoid process, thoracic outlet syndrome

Question 46

Fromet Paper sign

Answer 46

pt grips paper between fingers -unable to maintain grip indicaes ulnar nerve paraylsis

Question 47

Bracelet Test

Answer 47

seated. mild compressive pressure to dorsum of wrist. pt attempts to make fist - acute forearm, wrist and hand pain significant for RA

Question 48

Naffziger Test

Answer 48

seated. occlude both jugular veins for 30 secs. then pt coughs deeply. this is contraindicated for elderly. - radicular pain typically in lumbars, indicates space occupying lesion