Week 4: Assessment of Grip, Pinch, Edema

Question 1

What happens as axons regenerate through hand and Tinel’s sign occurs?

Answer 1

Hypoesthesia develops, hypersensitivity is positive sign of nerve growth

Question 2

Why is sensibility testing performed?

Answer 2

Assess recovery of nerve following laceration and repair as well as determine presence of nerve compression syndrome and return of nerve function

Question 3

What are reliable and sensitive tests for early detection of carpal tunnel syndrome?

Answer 3

Semmes-Weinstein and electrical testing

Question 4

How is moving touch tested?

Answer 4

Eraser placed in area of normal sensibility and moved to dotal fingertip, client notes when perception of stimulus changes (light and heavy pressure applied)

Question 5

T/F: Semmes-Weisein is most accurate instruments for assessing cutaneous pressure thresholds

Answer 5

True

Question 6

How should you perform monofilament pressure test?

Answer 6

• start in normal range than increase diameter range
• 2/3 correct are needed in one area to be considered having intact sensibility
• Need to place monofilaments randomly rather than in one area
• Graded from light touch (2.83+) to loss of protective sensation (-4.56)

Question 7

Guidelines for static 2 point discrimination test

Answer 7

1. vision occlude
2. area of normal sensation tested as reference
3. calipers set 10 mm apart and randomly applied, starting at fingertip and move proximally and longitudinally in line with digital nerves with one or two points touching
4. distance decreased until client can no longer feel 2 distinct points and that distance is measured
   Need to have 4/5 responses right

Question 8

What is normal two point discrimination at fingertip?

Answer 8

6 mm or less

Question 9

What does moving 2 point discrimination measure?

Answer 9

Innervation density of quickly adapting nerve fibers for touch (more sensitive than static test)

Question 10

How is moving 2 point discrimination tested?

Answer 10

1. vision occluded
2. area of normal sensation tested as reference
3. fingertip is supported by examining table or examiner’s hand
4. caliper, separated 5-8mm is moved longitudinally from proximal to distal in linear fashion along fingertip. One and two points are randomly alternated. Client must correctly identify stimulus in 7/8 responses before proceeding to smaller value.

Test repeated down to separation of 2 mm.

Question 11

T/F: 2 point values increase with age in both sexes with smallest values 10-30 y/o

Answer 11

True

Question 12

T/F: Women have smaller values than men

Answer 12

True

Question 13

T/F: There is no diff. between non dominant and dominant hand for 2 point discrimination

Answer 13

true

Question 14

What nerves does Moberg Pickup Test test?

Answer 14

Median nerve injury or median and ulnar

Question 15

What are steps to Moberg Pick Up test?

Answer 15

1. 9 or 10 small objects placed on table, client asked to place them one at a time in small container as quickly as possible while looking at them. Timed
2. Test repeated for opposite hand with vision
3. Test repeated for each hand with vision occluded.
4. Client asked to ID each object one at a time with and without vision

Question 16

Why do we look at hand volume?

Answer 16

Measuring edema important, look at it at different times of day to measure effects of rest versus activity and effects of splinting or intervention to reduce edema

Question 17

What is used to assess hand edema?

Answer 17

Volumeter

Question 18

What variables have been shown to decrease accuracy of voltmeter?

Answer 18

1. use of faucet or house that introduces air into tank during filling
2. Movement of arm within tank
3. Inconsistent pressure on stop rod
4. Use of voltmeter in variety of places

Question 19

T/F; Increased volume indicates presence of edema

Answer 19

True

Question 20

How is edema eval performed?

Answer 20

1. plastic voltmeter filled and allowed to empty into large beaker until water reaches spout level
2. client immerses hand in it and keep hand in mid position
3. hand lowered until rests between middle nd ring fingers on dowel rod. Hand cannot press onto the rod
4. Hand remains still until no more water drips into beaker
5. water poured into graduated cylinder and measure level

Question 21

T/F: strength testing done right after surgery/trauma

Answer 21

False. Done after healing phase of trauma

Question 22

What is used to assess grip strength?

Answer 22

Adjustable handle dynamometer

Question 23

How to use dynamometer?

Answer 23

1) seated with shoulder adducted and neutrally rotated
2) elbow flexed at 90
3) forearm in neutral position
4) wrist between 0 and 30 extension and between 0-15 ulnar deviation
3 trials taken of each hand and mean of 3 is reported. Noninjured hand used for comparison.

Question 24

How to assess pinch?

Answer 24

Pinch gauge

Question 25

What are three types of pinch?

Answer 25

``` Two point (thumb tip and index finger Lateral pinch 3 point pinch (thumb tip to tips of index and middle) ``` 3 trials bilaterally

Question 26

Why is assessment of hand function or performance important?

Answer 26

BC physical assessment does not measure client's ingenuity and ability to compensate for loss of strength, ROM, sensation or presence of abnormalities

Question 27

What test is this? Provide measurements of standardized tasks with norms for client comparison. ex) 7 subtests, write short sentence, turn cards, pick up objects, etc.) Good for overall hand function

Answer 27

Jebsen Test of Hand Function

Question 28

What test is this? measure ability to perform general arm and hand activities used in daily living. 6 parts: grasping, lifting two pipes, putting small washer over a nail, pour water in pitcher

Answer 28

Quantitative Test of UE Function

Question 29

Other tests for hand dexterity?

Answer 29

Crawford Small Parts Dext. Test Bennet Hand Tool Dex. Test Purdue Pegboard Test Minnesota manual Dex Test