Sample Q&A Elbow, hand, wrist Flashcards Preview

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Flashcards in Sample Q&A Elbow, hand, wrist Deck (116):
1

allen's test

tests the patency of the radial and ulnar arteries

2

positive allen's test

delay in refill of the hand (greater than 5 seconds)

3

indication of allen's test

loss of patency of the artery being tested

4

possible causes of allen's

subluxation, raynaud's, old fracture, scar tissue, TOS

5

positive finklestein's

1. unable to bring thumb across and/or muscle wasting
2. pain along the radila side of the forearm

6

indications for finklestein's

1. ulnar nerve palsy
2. stenosing tenosynovitis of DeQuervain

7

differential diagnoses for finklestein's

scaphoid fracture, carpal subluxation

8

treatment for positive Finkelstien's

ice, biomechanical correction

9

what tendons make up tunnel of dequervain?

extensor pollicis brevis
abductor pollicis longus

10

what are some causes of ulnar nerve palsy?

trauma to the ulnar nerve, elbow subluxation

11

froment's positive

patient's thumb flexes in order to hand onto the paper

12

indication for positive froment's

ulnar nerve palsy.
by flexing the thumb the patient recruits the median nerve in order to hand to the paper

13

most important thing to do for froment's during a practical?

doctor should make sure that they could visualize the patient's thumb. they must be able to see if the patient flexes the thumb

14

what ways are there to verify a positive froment's

look for thenar or hypo-thenar muscle wasting; loss of strength in muscle tests, or utilize EMG

15

english test

remember to occlude the arteries before pumping the hand (hold for 6- seconds)

16

positive english

upon removing the arterial occlusion the symptoms of CTS are reproduced

17

indication for positive english

carpal tunnel syndrome

18

two reasons english test works

hypoxia, pooling of blood around the carpal tunnel increases presure on the median nerve

19

when will you most often see a positive reaction in english test?

when you release the blood supply after it has already pooled (at the end)

20

phalen's test

hold position for up to a minut (if symptoms occur before one minute, stop test)

21

positive phalen's

reproduction of the symptoms of CTS

22

indication for positive phalen's

carpal tunnel syndrome

23

tinel tap test

perform for 10 seconds

24

positive tinel tap

reproduction of the symptoms of CTS

25

indication for tinel tap

capral tunnel syndrome

26

differential diagnoses for CTS

cervical subluxation
pronator nerest syndrome
elbow sulbuxation
shoulder subluxation
TOS
raynaud's
tenosynovitis of dequervain
ulnar nerve palsy
radila nerve palsy
fractures
trigger points on the thumb for stomach and liver

27

carpal tunnel syndrome symptoms

pain
paresthesia
numbness and tinglig in median nerve distribution

28

what is the length of time for performing the english test

hold up for a minute or if CTS symptoms appear before the minute is up

29

name two tests to verify a psotivie tinel tap

tests that could verify are phalen's and english

30

what is the direction of carpal misalignment in CTS?

anterior lunate

31

is the lunate usually hypermobile or hypomobile in CTS?

lunate is usually hypermobile

32

what makes up the carpal tunnel

lunate at the posterior aspect and the transverse carpal ligament at the anteiror aspect

33

what are the contents of the carpal tunnel

9 flexor tenodns and the median nerve

34

the adjusting move of choice for CTS

wrist traction, FLEXION ONLY

35

best CTS post check

repeat the orthopedic tests that were positve on the pre-check

36

which CTS test would you not do as a post check and why?

don't do reverse phalen's, it would drive lunate anterior

37

what would you do after treating CTS?

after adjustment, brace or support the wrist then strengthening exercises

38

What procedure should the doctor perform to help differentially diagnose with a positive cozen or mill's test?

palpate for tenderness
palpate to differntiate whether the pain is over the radial head or lateral epidondyle

39

what treamtent protocol would you perform for a lateral epicondylitis?

correct any biomechanical dysfunction, protect, ice the swelling, wear counter force armband, and change activities for the elbow as this alters the fulcrum for extension so ti's not directly over the alteral epicondyle

40

postive cozen's

pain over the lateral epicondyle

41

indication for positive cozen's

lateral epicondylitis

42

positive mill's

pain over lateral epicondyle

43

indication for positve mill's

lateral epicondylitis

44

if lift test is postive what wouldthe doctor utuilze to help differentially diangose the cause of the finding?

positive- pain over epicondyle
indication- epicondylitis

45

postive lift test in pronation?

pain over lateral epicondyle

46

indication for positive lift test in pronation

lateral epicondyliits

47

if lift test was done in pronation, what else should you look for?

possible radius P with pain over radial head and decreased radila fluid motion

48

positive lift test in supination

pain over medial epicondyle

49

indication for postive lift test in supination

medial epicondylitis

50

if lift test was done in supination, what should you look for?

ulna P with pain 1-1.5 inches distal to the medial epicondyle, and decreased fluid motion
look for possible ulna PM with pain over the olecranon fossa area, and decreased fluid mmotion

51

positive adson's

decrease in radial pulse amplitue (or absence of radial pulse)

52

indication for postive adson's

scalenus anticus syndrome
pressure on the subclavian artery and brachial plexus
between the scalenus anticus
scalenus medius
1st rib

53

how long do you palpate the radial artery when performing Adon's

from 10-20 seconds, enough to decide if the pulse volume has changed

54

scalenus anticus syndrome is usually caused by?

subluxation

55

What do you do for a patient with scalenus anticus syndrome?

adjust the subluxation, use moist heat to relax muscles and stretch

56

what diangosis si suspected with a psitive adson't when the head is turned away from the side being palpated?

may be scalenus medius syndrome or a cervical rib

57

is a cerivcal rib that causes loss of patency acute or chonic

usually acute exacerbation, because bone will normally modify away from the artery

58

positive eden's

decrease inradial pulse amplitude (or absence of radila pulse

59

indication for postive eden's

costoclavicular syndrome (TOS)

60

how to treat for a postive eden's test?

determine if it is due to muscle guarding often a hypertonic pectoralis major, which needs to be stretched out
could also be a cervical, thoracic or rib that is subluxated

61

what questions might you ask a patient that has eden's test postivie?

do they carry a backpack or heavy objects in front of them at work?
have they ever had an accident with the seatbelt on, fractured or dislocated their clavicle, or had shoulder problems?

62

positive wright's

decrease in radial pulse amplitude (or absence of radial pulse)

63

indication of postive wright's

hyperabduction syndrome (TOS)

64

what constitutes a positive wright's test?

a 10-15 degree difference in left vs right arm abduction
you're coparing where you lose the palpabe radial pulse from one arm to another

65

what is the most common muscle involed witha positive wright's?

pec minor

66

what causes the pec minor to be shortened ro go into contracture?

cervical subluxation, subacromial bursitis, rolled posture, other types of TOS

67

which 3 subluxations would elbow traction work well for?

ulna P
ulna PM
radius P

68

what subluxation would elbow traction be most effective for?

ulna P

69

how would you post check elbow traction?

check the fluid motion that was lost in the pre-check; look for diminished pain point, and improved elbow extension ROM

70

when adjusting elbow subluxations when would you supinate and when would you pronate?

you would pronate for radius P and supinate for ulna P and ulna PM

71

What is the CP for radius P?

tip of thumb

72

what ROM are utilized during the radius P procedure?

full extension and full pronation

73

what is the pain point for radius P

right over the head of the radius

74

what are some differential diagnoses for radius P?

lateral epicondylitis, cervical subluxation (C5-6 area)

75

what ROM is decreased with radius P?

pronation

76

what subluxation might mimic the symptoms of lateral epicondylitis?

radius P

77

what is the pain point for ulna P?

1-1 1/2 inches distal to the medial epicondyle

78

what ROM are utilized during the ulna PM procedure?

supination and extension

79

what is the pain point for ulna PM?

olecranon fossa area

80

what is the major LOD for ulna PM?

P-A even though the DC and SCP are on the medial side of the arm

81

what ROM is deceased with ulna P and PM?

extension

82

what is the most common direction for the carpals to misalign?

posterior

83

what is the best post check for wrist traction?

fluid motion between carpals that were adjusted

84

where is the pain point for wrist traction?

right over the carpal that is misaligned

85

what are you stabilization hand fingers stabilizing the capitate STH?

proximal row of carpals

86

what ROMdo you tak the patient's hand through while performing scaphoid DTH?

extension and radila deviation

87

what carpals do you test the scaphoid against for fluid motion?

trapezium, trapezoid, lunate

88

what are som differential diagnoses for a trapezium-scaphoid subluxation?

scaphoid fracture, DJD, stenosing tenosynovitis of dequervain, subluxation of scapho-lunate, trapezium 1st metacarpal

89

how would you differentiate the diagnostic possiblilities for a trapezium-scaphoid subluxation?

for the subluxation, you'd perform fluid motion, check pain points, utilize information from the case history, and xray.
for DJD, check xray and perform lab tests to differentiate the type of arthritis.
for stenosing tenosynovitis of dequervain perform finklestein's.
for a scaphoid fracture xray, wait 10 days then xray again

90

is ther a difference between DJD and arthritis?

arthritis has inflammation, therefore you'd want to deal with any swelling befor adjusting to improve motion

91

what differnetila diagnoses should be ruled out before adjusting a scaphoid?

check for scaphoid fracture, radial styloid fracture, stenosing tenosynovitis of dequervain, other carpal subluxations, etc

92

name the wrist adjusting procedures from lead to most invasive

wrist traction, STH, DTH

93

the lunate usually misaligns in which direction?

posterior

94

in CTS the lunate usually misaligns in which direction?

anterior

95

which arpal is most common wrist subluxation?

lunate

96

what carpal is the 2nd most common wrist subluxation?

capitate

97

wich carpal is the 3rd most common wrist subluxation?

scaphoid

98

is the posterior lunate misalignemtn hypermobil or hypo mobile?

hypomobile

99

describe wrist traction maneuver CTS

traction S-I, flex
return to neutral

100

describe wrist traction maneuver for subluxation of a capal

traction S-I, flex, extend, return to neutral, release

101

what would be the move of choice when fluid motion is lost between scaphoid and lunate?

traction (transverse/horizontal) would be the move of choice, then STH, then DTH)

102

describe the scaphoid STH procedure

traction, extend and radially deviate

103

when is it very important to be sure of when perfomring the scaphoid DTH?

that all fingers are stabilizing the carapls aorund the scaphoid

104

what stabilizes the radius duing the scaphoid DTH?

patient's own body weight

105

how would you perform wrist raction iwth a hypermibile anterior lunate?

traction S-I, flexion, return to neutral (DO NOT EXTEND)

106

where is the pain point for CMC joints

right over the joint

107

what direction does the 2nd CMC sulbuxated?

rotationally

108

how can a first metacarpal subluxation be identified?

look for loss of fluid motion, joint tenderness at the CMC joint, and a case history of jammed thumb, etc

109

which ROM is the most prevalent at the metacarpal-carpal joints?

rotation (hand cupping), not much in extension or flexion

110

what are some differntila diagnoses for a CMC 1st subluxation?

scaphoid subluxation, scpahoid fracture, trapezium fracture, stenosing tenosynovitis of dequervain, median nerve disturbance

111

what is the best way to post check the 2nd CMC

fluid motion

112

which one f the CMC 2-5 would be the most mobile?

5th CMC

113

how would you determine a CMC2-5 subluxation?

stabilize the distal row of carpals and rotate each metacarpal (relative to it's adjacent carpal) to see if they have fludi motion. pain over CMC joint.
a case history with possibly a blow to the area, use of power tools, area was stepped on, a cast was recently removed, etc

114

what are normal ROMs for MCP and IP joints of the hand?

they should have glide from P-A and A-P as well as rotation

115

what type of joint pathologies would you perform MCP and IP traction for?

you would adjust the MCP and IP joints with traction for subluxation, jammed fingers, arthritic fingers, DJD, etc

116

what types of joint pathologies are MCP and IP traction good for?

any joint fixation, subluxation or dislocation, jammed finger, arthridities, DJD