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A: MSK UQ > Lab 14: Wrist/hand Exam And Treatment > Flashcards

Lab 14: Wrist/hand Exam And Treatment Flashcards

(100 cards)

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1
Q

What are important DDX causes for the wrist and hand pain

A

• Tenosynovitis
• Instability
• Fracture/dislocation
• Neurovascular injury
• Non-MSK cause

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2
Q

What are the active movements of the wrist

A

• Flexion: 80º - 90º
• Extension: 70º - 90º
• Radial deviation: 15º
• Ulnar deviation: 30º - 45º
• Forearm supination: 85º +
• Forearm pronation: 75º +

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3
Q

When would u do PROM

A

If AROM is limited

Over pressure in NT if AROM is painful

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4
Q

What are active movements of finger flexion and finer extenion

A

• Finger flexion
• MCP: 80º – 90º
• PIP: 100º – 115º
• DIP: 80º – 90º
• Finger extension
• MCP: 30º – 45º
• PIP: 0º
• DIP: 20º

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5
Q

What are active movements of thumb flexion

A

• CMC: 45º – 50º
• MCP: 50º – 55º
• IP: 85º – 90º

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6
Q

What are active movements of thumb extenion

A

• CMC: 20
• MCP: 0
• IP: 0-5

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7
Q

What is the ° of thumb abduction and adduction

A

• Thumb abduction: 60º – 70º
• Thumb adduction: 30º

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8
Q

What are the functions ROM for power grips and what does it assess

A
  • hook
  • spherical
  • cylinder
  • fist
  • assessing both ROM and reproduction of symptoms
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9
Q

What are the precision grips u can assess for functional ROM

A
  • chuck or three fingered pinch
  • laterla or key pinch
  • tip pinch
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10
Q

What range do u test resisted isometric movements in for the wrist and hand

A

Neutral position

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11
Q

What mm are u resisted testing for the wrist

A

• FCR/FCU
• ECRL/ECRB
• ECU

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12
Q

What mm are u resisted testing for the thumb

A

• APL/APB
• Opponens pollicis
• FPL/FPB
• Adductor pollicis
• EPL/EPB

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13
Q

What mm are u resisted testing for the intrinsic

A

• Lumbricals
• Palmar interossei
• Dorsal interossei

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14
Q

What mm are u resisted testing for the fingers

A

• FDP
• FDS
• EI/ED
• Flexor digiti minimi
• Opponens digiti minimi

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15
Q

What is the normal difference between R and L for the functional grip tests w dynamometer

A

Up to 10% if it is more then 20% then may indicate pt is not giving make forces

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16
Q

How many trials do u do for the f unctional Grip Tests w/ dynamometer

A

3 trials and get the mean

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17
Q

What joint plat can u do at teh DRUJ

A

Anterior and posterior glide

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18
Q

What does antieorn and posterior glide help improve at the DRUJ

A

Anterior: increased pronation

Posterior: increased supination

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19
Q

What is moving on what during joint play at the DRUJ

A

Radius is moving on ulna so concave on convex ( opposite in the PRUJ)

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20
Q

Should u check only the affected side when doing joint play or both sides

A

Both sides os u can compare side to side

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21
Q

What does distraction , anterior and posterior glide helo improve during joint play ath the radio carpal joint

A

• Distraction- ↑ all wrist motions
• Anterior glide- ↑ wrist extension ROM
• Posterior glide- ↑ wrist flexion ROM

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22
Q

What does ulnar and radial glide help improve during joint play ath the radio carpal joint

A

• Ulnar (medial) glide- ↑ radial deviation ROM
• Radial (lateral) glide- ↑ ulnar deviation ROM

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23
Q

What does ulnar and radial glide help improve during joint play at the mid carpal joints

A

• Ulnar (medial) glide- ↑ radial deviation ROM
• Radial (lateral) glide- ↑ ulnar deviation ROM

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24
Q

What is the articulation at the radio carpal joint

A

Proximal carpal joint (convex) on the radius (concave)

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25
What does distraction , anterior and posterior glide helo improve during joint play at the mid carpal joints
• Distraction- ↑ all wrist motions • Anterior glide- ↑ wrist extension ROM • Posterior glide- ↑ wrist flexion ROM
26
What is the articulation of the mid carpal joints.
Proximal row of carpals moving on distal row (Convex on concave)
27
What is the articulation of the carpo metacarpal joints
Concave proximal metacarpal on convex distal carpal row
28
What is the joint play at the 2nd-5th CMC joint
Distraction Anterior Postieor
29
What does distraction , anterior glide and posteior glide help improve at the 2nd -5th CMC joint s
• Distraction: ↑ all finger motions • Anterior glide: ↑ finger flexion ROM • Posterior glide: ↑ finger extension ROM
30
What are the possible joint plays at the 1st CMC joint
* distraction * anterior/posteoir glide * ulnar/radial glide
31
What does distraction , anterior and posterior glide help improve at the 1st CMC joint
• Distraction: ↑ all finger motions • Anterior glide : ↑ thumb adduction ROM • Posterior glide: ↑ thumb abduction ROM
32
What does ulnar and radial glide help improve at the 1st CMC joint
• Ulnar (medial) glide : ↑ thumb flexion ROM • Radial (lateral) glide : ↑ thumb extension ROM
33
What is the first bone u should feel when coming down the thumb
Scaphoid
34
What kind of joint is the 1st CMC
Saddle joint
35
What is the articulation of the MCP joitns
Concave proximal phalanx on convex distal metacarpal
36
What does distraction , anterior and posteiror glides help improve at the MCP joints
• Distraction: ↑ all finger motions • Anterior glide: ↑ finger flexion ROM • Posterior glide: ↑ finger extension ROM
37
What does ulanr and radial glides help improve at the MCP joints
• Ulnar (medial) glide: ↑ finger adduction/abduction ROM (as compared to 3rd ray) • Radial (lateral) glide: ↑ finger adduction/abduction ROM (as compared to 3rd ray
38
What does ulanr and radial glides help improve at the MCP joints
39
What mm do you do resisted testing for at the thumb
• APL/APB • Opponens pollicis • FPL/FPB • Adductor pollicis • EPL/EPB
40
What mm do u do resisted testing for the intrinsics
• Lumbricals • Palmar interossei • Dorsal interossei
41
What mm do u do resisted testing for at the fingers
• FDP • FDS • EI/ED • Flexor digiti minimi • Opponens digiti minimi
42
What is the nomral difference in functional grip tests with dynamometer in R and L hands
10% If > 20% they it may indicate patient is not giving max forces
43
How many times do u do the Functional Grip Tests w/ dynamometer
3 trials and get the mean then compare it with normla values by age and gender
44
What joint play can u do at the DRUJ
Anterior and posterior glide
45
What does anterior glide and posterior glide at the DRUJ help improve
Anterior : increased pronation Posterior: increased supination
46
When u are doing joint play at the distal radio ulnar joint what is moving
Radius is moving on the ulna So concave on convex (opposite from the PRUJ)
47
When doing joint play of the wrist do u need to check both sides or just the affected side
Both sides so u can compare to see if it is really hypo
48
What joint play can u do at the radio carpal joint
* distraction * anterior/posterior Glide * ulnar (medial) / radial (lateral) glide
49
What does distraction , anterior and posterior glide at the radio carpal joint help improve
• Distraction- ↑ all wrist motions • Anterior glide- ↑ wrist extension ROM • Posterior glide -↑ wrist flexion ROM
50
What does ulnar and radial glide at the radio carpal joint help improve
Ulnar: increased radial deviation Radial: increased ulnar deviation
51
What is the articulation of the radio carpal joint ?
Proximal carpal joints (convex) on radius (concave)
52
What joint play can u do at the mid carpal joints
* distraction * anterior/posterior Glide * ulnar (medial) / radial (lateral) glide
53
What does distraction , anterior and posterior glide help improve at the mid carpal joints
• Distraction-↑ all wrist motions • Anterior glide- ↑ wrist extension ROM • Posterior glide - ↑ wrist flexion ROM
54
What does ulnar and radial glide help improve at the mid carpal joints
Ulnar: increased radial deviation Radial: increased ulnar deviation
55
What is the articulation of the mid carpal joints
ConvexProximal row moving on concave distal rol
56
What does distraction , anterior slige , posteiror glide help improved at the CMC joints of 2nd-5th
• Distraction :↑ all finger motions • Anterior glide : ↑ finger flexion ROM • Posterior glide : ↑ finger extension ROM
57
What does distraction , anterior glide , and posterior glide of the 1st CMC joint help improve
• Distraction : ↑ all finger motions • Anterior glide : ↑ thumb adduction ROM • Posterior glide : ↑ thumb abduction ROM
58
What does the ulanr and radial glide joint play of the 1st CMC joint help improve
• Ulnar (medial) glide : ↑ thumb flexion ROM • Radial (lateral) glide :↑ thumb extension ROM
59
What is the articulation of the carpo metacarpal joint
Concave proximal meta carpal on convex distal carpal row
60
What is the articulation of the MCP joint
Concave prox phalanx on convex distal metacarpal
61
What does distraction , anterior and posterior glide joint play help improve at the MCP joint
• Distraction :↑ all finger motions • Anterior glide : ↑ finger flexion ROM • Posterior glide : ↑ finger extension ROM
62
What does ulnar and radial glide help improve at the MCP joint
• Ulnar (medial) glide : ↑ finger adduction/abduction ROM (as compared to 3rd ray) • Radial (lateral) glide : ↑ finger adduction/abduction ROM (as compared to 3rd ray
63
What is the articulation of teh PIP and DIP joints
PIP: concex proximal phalanx- distal on concave middle phalanx - proximal DIP: convex ( middle phalanx distal) on convex ( distal phalanx - proximal)
64
What does distraction , anterio glide and posterior glide help improve for teh PIP an d DIPq
• Distraction • ↑ all finger motions • Anterior glide • ↑ finger flexion ROM • Posterior glide • ↑ finger extension ROM
65
What are special test for Ligament, Capsule and Joint Stability
• Ligamentous instability of fingers • Thumb ulnar collateral instability test • Watson shift test • Ballotement test • Murphy’s sign • Piano key test
66
What are special test for tendons and mm
Finkelstein test
67
What are special test for neurological dysfucntion
• Tinel’s sign at wrist • Phalan’s test • Fromment’s Sign
68
What special test is for circulation and swelling
Allens test
69
How do u test ligamentous instability of the fingers
* pt stabilizes w 1 hand proximal to the joint being test * w other hand , grab the finger distal to the joint being test * PT distal hand applies a varus or valgus stress to joint (+) if excessive motion
70
How do u do the thumb ulanr collaterla ligament instability test
* stabilize pt hand and MC w 1 hand * flex MCP joint to 30° and apply a valgus stress * (+) excess abduction compared to other side
71
What is a test for game keepers or skiers thumb
Thumb ulnar collateral ligament instability test
72
What does the Watson (scaphoid) shift test assess
Scapho lunate instability
73
How do u perform the Watson (scaphoid) shift test
Start w ulnar deviation and extension then move wrist into radial deviation and slight flexion
74
What is a (+) test for Watson (scaphoid) shift test
Subluxation or clunk over examiners thumb= tear of scapho lunate ligament
75
What does the ballotement test assess
Luno triquetral instability
76
What test assess luno-triquetral instability
Ballotement test
77
How do u perform a ballotement test
* grasp triquetrum b/t thumb and 2nd finger and the lunate w thumb and 2nd finger or other hand * move lunate palmarly and dorsallt w respect to triquetrum
78
What is a (+) test for ballotement test
laxity, crepitus, or reproduction of pt’s pain during A-P movement = luno- triquetral ligament tear
79
What test is used to assess if lunate is dislocated
Murphy sign
80
What way does the lunate usually dislocate
Volar
81
How do u do the Murphy sign
* knuckle formed by the head of the 3rd MC is more prominent and protrudes further distally as compared to other knuckles
82
What is a (+) test for Murphy sign
9 f knuckle of 3rd metacarpal head is level w/ knuckles of 2nd and 4th metacarpal heads = a lunate dislocation
83
What does the piano key test assess
Triangular fibrocartilage complex test
84
What test is used to assess TFCC tear
Piano key test
85
How do u do the piano key test
* put thumb over dorsal part of ulna then perform a dorsal glide of pisiform/triquetrum
86
What is a (+) sign for piano key tes
reproduction of pain or laxity in ulno-menisco-triquetral region = TFCC tear (triquetral instability
87
What does finkelstein test assess
for de Quervain’s disease (paratendinitis of thumb)
88
What test is used to assess for de Quervain’s disease (paratendinitis of thumb)
Finkelstein test
89
How do u perform finkelstein test
* pt make a fist with thumb inside of fingers * PT deviates wrist toward ulnar side
90
What is a (+) test for finkelstein test
pain reproduction over APL and EPB tendons
91
What test is used to assess for carpal tunnel syndrome
Tinels sign at the wrist Phalan’s test (wrist flexion)
92
How do u do the phalan’s test
PT puts pt wrist into maximal flexion and holds for one minute
93
What is a (+) test for phalan’s test
tingling in 1st -3rd and medial half of 4th digits (median n.)
94
What test is used to test for ulnar nerve paralysis
Fromment’s sign
95
How do u do fromments sign
* pt attempts to grab a piece of paper with laterla pretension (thumb and index finger) * PT tries to pull it away
96
What is a (+) test for formments sign
Flexion at the IP joint of the thumb bc of paralysis of adductor pollicis If thumb MCP joint hyperextends (Jeanne’s sign) , indicates ulnar n
97
What is the Allen test used to assess
Patency of the radial na ulnar artieries and which of them provides the majority of blood supply to the hand
98
How do u perform the Allen’s test
* pt is asked to open and close hand 5x as fast as possible and then squeeze hand tightly * PT palpates radial and ulanr artiieris , compressing them both * pt then open hand while pressure is maintained over both artieries * one artery is test by releasing the pressure and see if the hand flushes and then other artiery is tested
99
What is a (+) and (-) test of Allen’s test
• (+) test: if color returns to hand w/i 6-10 seconds then circulation is normal • (-) test indicates pathology: pallor remains after 6-10 seconds = compromised blood flow on the side that was released
100

A: MSK UQ (30 decks)

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