Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

msk 3 midterm > wrist and hand exam > Flashcards

wrist and hand exam Flashcards

(120 cards)

Start Studying
1
Q

FOOSH can lead to

A

Scaphoid or distal radius (Colle’s) fracture
Lunate dislocation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Clicking and popping sounds in a joint, especially after a FOOSH injury or repetitive use, can be signs of joint instability:

A

Ligament injury or tear – Damage to stabilizing ligaments (e.g., scapholunate ligament in the wrist) can cause abnormal movement of the bones

Damage to articular cartilage (such as a labral tear in the shoulder)

Partial or complete dislocation can lead to abnormal positioning and movement of bones

Tendons that have become misaligned or irritated (like the extensor carpi ulnaris tendon in the wrist)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

In an inflammatory condition, the following symptoms typically appear:

A

Insidious onset of pain – The pain gradually develops over time, rather than being linked to a specific traumatic event or mechanical injury.

Redness – The affected area may appear red due to increased blood flow from the inflammatory response.

Swelling – Fluid accumulation or joint effusion often occurs, leading to noticeable swelling.

No mechanism of injury (MOI) – The pain and other symptoms arise without a clear cause, often linked to autoimmune or systemic issues rather than trauma or overuse.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Insidious hand pain refers to pain that develops gradually over time, without an obvious injury or traumatic event. Possible causes of insidious hand pain include:

A

Osteoarthritis
Rheumatoid arthritis
Carpal Tunnel Syndrome (CTS)
Tendinitis or tenosynovitis
Trigger finger
Gout
Infective arthritis
Polyarthritis
Vascular disorders

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Osteoarthritis –

A

Degeneration of joint cartilage, commonly affecting the thumb (CMC joint), causing stiffness, pain, and swelling.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Rheumatoid arthritis –

A

An autoimmune condition that leads to joint inflammation, particularly in the small joints of the hands, often accompanied by swelling, stiffness, and deformities.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Carpal Tunnel Syndrome (CTS) –

A

Compression of the median nerve in the wrist, resulting in pain, numbness, and tingling that may worsen over time, especially at night.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Tendinitis or tenosynovitis –

A

Chronic overuse or repetitive strain leading to inflammation of the tendons, causing gradual pain and swelling (e.g., De Quervain’s tenosynovitis).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Trigger finger –

A

Inflammation or thickening of the tendons, making finger movement painful and causing locking or catching.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Gout -

A

Uric acid crystals accumulate in joints, often due to high uric acid levels in the blood

Sudden, severe attacks of pain, redness, and swelling, commonly affecting the small joints of the fingers or wrists

Gout flares often occur at night and can be triggered by diet, alcohol, or dehydration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Infective (Septic) Arthritis -

A

Bacterial, viral, or fungal infection in the joint, leading to inflammation

Acute onset of severe pain, warmth, redness, and swelling, often accompanied by fever and systemic symptoms

The affected joint may become stiff and difficult to move.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Polyarthritis -

A

Inflammation of multiple joints, often associated with autoimmune conditions like rheumatoid arthritis, lupus, or psoriatic arthritis

Symmetrical involvement of multiple joints, including the hands, with swelling, pain, and morning stiffness lasting more than 30 minute

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Vascular Disorders -

A

Compromised blood flow due to conditions like Raynaud’s phenomenon, peripheral artery disease (PAD), or vasculitis

Cold, pale, or bluish fingers with pain, tingling, or numbness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

common deformities associated with rheumatoid arthritis (RA):

A

Boutonniere Deformity of thumb

Ulnar Deviation of Metacarpophalangeal (MCP) Joints

Swan-Neck Deformity of fingers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Boutonniere Deformity

A

Flexion of the proximal interphalangeal (PIP) joint and hyperextension of the distal interphalangeal (DIP) joint

Cause: Damage or rupture of the central slip of the extensor tendon at the PIP joint

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Ulnar Deviation of Metacarpophalangeal (MCP) Joints

A

Deviation of the fingers toward the ulnar side (pinky side) at the MCP joints

Cause: weakening of joint capsules and ligaments leads to drifting of the fingers toward the ulnar side

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Swan-Neck Deformity

A

Hyperextension of the PIP joint and flexion of the DIP joint

Cause: Imbalance between the flexor and extensor mechanisms of the finger

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Resting position of the hand:

A

Finger flexion greater moving from radial to ulnar direction, normal arches (longitudinal/transverse), thumb slight abduction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Muscle wasting:

A

thenar (median n)

1st dorsal interosseous muscle (C7)

hypothenar (ulnar n)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Thenar Muscle Wasting (Median Nerve)

A

abductor pollicis brevis, flexor pollicis brevis, and opponens pollicis

Compression or damage to the median nerve, often due to conditions like carpal tunnel syndrome (CTS)

the rounded area at the base of the thumb), along with weakness in thumb opposition, abduction, and flexion

struggle with gripping or pinching motions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

First Dorsal Interosseous Muscle Wasting (C7)

A

primarily innervated by the ulnar nerve, but involvement of the C7 nerve root can indirectly impact this muscle

cervical radiculopathy, nerve compression, cubital tunnel syndrome

Wasting between the thumb and index finger (first web space), leading to weakness in finger abduction and reduced pinch strength

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Hypothenar Muscle Wasting (Ulnar Nerve)

A

abductor digiti minimi, flexor digiti minimi brevis, and opponens digiti minimi

ulnar nerve entrapment at the elbow (cubital tunnel syndrome) or at the wrist (Guyon’s canal syndrome)

Wasting of the hypothenar eminence (the rounded area at the base of the little finger), along with weakness in movements of the pinky finger, including abduction, opposition, and flexion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Complex Regional Pain Syndrome (CRPS)

A

often develops after an injury (e.g., a fracture or surgery) and involves persistent pain, swelling, and autonomic disturbances.

Vasomotor changes: Abnormal skin temperature (cold or warm), skin color changes, and altered sweating.

Trophic changes: Shiny skin, hair loss, brittle or ridged fingernails, and skin atrophy.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Peripheral Nerve Damage (Neuropathy)

A

Conditions like diabetic neuropathy or entrapment syndromes (e.g., carpal tunnel syndrome) can lead to impaired autonomic function.

The affected nerves may cause vasomotor symptoms like temperature differences and trophic changes, including loss of hair and nail brittleness in the distribution of the damaged nerve.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Peripheral Artery Disease (PAD)
Decreased blood flow due to arterial blockages can lead to trophic changes, such as shiny skin, hair loss on the legs, brittle nails, and poor wound healing. Cold extremities or a noticeable temperature difference between limbs can also be observed.
26
Raynaud’s Phenomenon
A vasomotor disorder triggered by cold or stress, causing changes in blood flow to the fingers or toes. Prolonged cases may lead to trophic changes like brittle nails, thinning skin, and even ulcers due to poor circulation.
27
Autonomic Neuropathy
Seen in conditions like diabetes or autoimmune diseases, where the autonomic nervous system is damaged, leading to issues with sweating regulation (too much or too little) and temperature dysregulation.
28
Chronic Nerve Compression
Prolonged compression, such as in carpal tunnel syndrome or thoracic outlet syndrome, may impair blood supply and autonomic function, causing vasomotor and trophic changes, including changes in sweating, skin texture, and nail growth.
29
Heberden’s Nodes
Location: Affect the distal interphalangeal (DIP) joints (the joints closest to the tips of the fingers). Associated with: Osteoarthritis of the DIP joints. Appearance: These are hard, bony swellings that develop over time due to cartilage degeneration and the formation of osteophytes (bone spurs). Symptoms: They can cause stiffness, reduced range of motion, and pain, although some people may have painless nodes.
30
Bouchard’s Nodes
Location: Affect the proximal interphalangeal (PIP) joints (the middle joints of the fingers). Associated with: Osteoarthritis of the PIP joints. Appearance: Similar to Heberden’s nodes but occur at a different location. These bony enlargements also result from cartilage breakdown and osteophyte formation. Symptoms: Similar to Heberden’s nodes, they may cause pain, stiffness, and difficulty with finger movement.
31
Spoon shaped fingernails =
fungal infection, anemia, iron deficiency, diabetes, long time injury, psoriasis
32
Clubbed nails =
(hypertrophy of nail bed, COPD, congenital heart defect, cor pulmonale)
33
+ Froment sign =
inability to pinch between thumb and index finger without flexion of the DIP occurring- weakness of AP, FPB assess for ulnar nerve dysfunction, particularly indicating weakness in the adductor pollicis (AP) and flexor pollicis brevis (FPB) muscles If these muscles are weak or paralyzed due to ulnar nerve damage, compensation occurs through the flexor pollicis longus (FPL), which is innervated by the median nerve.
34
Intrinsic Minus –
combined ulnar and median nerve loss Claw Hand): Caused by intrinsic muscle weakness, leading to MCP hyperextension and PIP/DIP flexion (e.g., ulnar nerve injury) weakness or paralysis of the intrinsic muscles (interossei and lumbricals) When these muscles are weakened, the extrinsic flexors and extensors dominate
35
Intrinsic Plus –
90 dg MCP flex, PIP/DIP ext, interossei and lumbricals at shortest position, common in patients with RA Caused by intrinsic muscle dominance, leading to MCP flexion and PIP/DIP extension (e.g., intrinsic muscle spasticity or extrinsic muscle weakness) Rheumatoid arthritis or intrinsic muscle contractures may lead to this position due to joint or muscle changes "safe position" for hand splinting "lumbrical grip”
36
Limited Extension of hand:
Potential Causes: Joint stiffness, contractures, arthritis, or tendon injuries. Possible Conditions: Rheumatoid arthritis, Dupuytren’s contracture, tenosynovitis
37
Limited Flexion of hand:
Potential Causes: Weakness in flexor muscles, pain, or joint damage. Possible Conditions: Tendon injuries, flexor tendinitis, neurological issues.
38
Pain on Opening the Hand:
Potential Causes: Flexor tendon issues, joint inflammation, or irritation. Possible Conditions: Tenosynovitis, rheumatoid arthritis, or trigger finger.
39
Pain on Closing the Hand:
Potential Causes: Weakness or strain in flexor muscles, joint pain, or structural issues. Possible Conditions: Tendonitis, carpal tunnel syndrome, or osteoarthritis.
40
Importance of Pad-to-Pad Mobility
allows for precise pinching, gripping, and manipulation of objects Test each finger individually Restricted Mobility: Suggests potential issues with joint range of motion, tendon flexibility, or muscle strength, which may impact functional tasks. Arthritis, joint deformities, or contractures can limit finger extension and thumb movement. Tendon injuries or tightness can restrict the ability to bring the pads together effectively. Weakness or coordination problems due to nerve damage or muscle dysfunction can affect pinching ability.
41
most functional activities, having at least ___ of opening between the thumb and fingers is crucial
5 cm
42
The ability to make three different fists:
standard straight hook
43
Standard fist
Power The fingers are curled into the palm, and the thumb wraps around the outside, forming a tight grip checks for the integrity of the flexor digitorum profundus (FDP) and flexor digitorum superficialis (FDS) tendons Difficulty forming this fist may indicate damage to flexor tendons, median or ulnar nerve pathology, or joint issues like arthritis
44
Hook Fist
(placing fingertips onto MCP joints) proximal interphalangeal (PIP) and distal interphalangeal (DIP) joints are flexed, while the metacarpophalangeal (MCP) joints remain extended primarily tests the function of the flexor digitorum profundus (FDP) tendons, which flex the DIP joints
45
Straight Fist (Lumbrical Plus)
(placing fingertips on the thenar and hypothenar eminences). The ability to flex the fingers to within 1–2 cm of the distal anterior (palmar) crease is an indication of functional range of motion for many hand activities MCP joints are flexed while the PIP and DIP joints are extended. The fingers are positioned flat against the palm without curling tests the lumbrical muscles and the flexor digitorum superficialis (FDS) tendons, which flex the PIP joints without engaging the FDP nability to form this fist suggests issues with the FDS tendons or median nerve dysfunction, as the FDS is crucial for isolated PIP joint flexion
46
Edema assessment:
“Volumetry”= water displacement as a measure of volume, is considered the gold standard for measuring hand size. Circumferential measurements
47
Loose wrist/hand:
wrist instability: DRUJ VISI/DISI UCL sprain CMC OA RA
48
Distal Radioulnar Joint (DRUJ) Instability
Injury or laxity of the ligaments stabilizing the DRUJ, commonly due to trauma (like a FOOSH injury) or degenerative changes Pain on the ulnar side of the wrist, especially during rotational movements like pronation and supination
49
Volar Intercalated Segment Instability (VISI)
collapse of the lunate in a volar direction (towards the palm), often due to ligament injuries = lunotriquetral ligament Wrist pain and instability, especially with wrist flexion and ulnar deviation may not be as noticeable as a DISI
50
Dorsal Intercalated Segment Instability (DISI)
collapse of the lunate dorsally (towards the back of the hand), due to injury to the scapholunate ligament Pain and instability, especially with wrist extension
51
Ulnar Collateral Ligament (UCL) Sprain
"skier’s thumb" or "gamekeeper’s thumb forceful abduction or hyperextension of the thumb Pain and swelling at the base of the thumb, especially with pinching or gripping
52
Carpometacarpal Osteoarthritis (CMC OA)
Degenerative changes in the thumb CMC joint (the trapeziometacarpal joint), leading to cartilage breakdown and joint instability Pain at the base of the thumb, especially with pinching and gripping, along with swelling, joint stiffness, and visible deformity
53
Rheumatoid Arthritis (RA)
autoimmune condition that leads to chronic inflammation of the joints Symmetrical swelling, pain, and instability in multiple joints of the hands and wrists deformities include ulnar deviation of the MCP joints, boutonniere deformity, and swan-neck deformity
54
Stiff wrist/hand:
OA post-immobolization Post-fx post-operative CMC OA RA
55
Post-Immobilization
Stiffness following a period of immobilization (e.g., casting or splinting) due to reduced joint movement and soft tissue changes Limited range of motion, pain, and stiffness in the affected joint and surrounding tissues after the removal of the cast
56
Post-Fracture (Post-Fx)
Stiffness and reduced range of motion following a fracture due to immobilization Joint stiffness, pain, and limited movement in the area surrounding the fracture site
57
Post-Operative
due to inflammation, scar tissue formation, or immobilization Reduced range of motion, swelling, and pain around the surgical site.
58
Painful wrist:
CTS DeQuervain's tenosynovitis CMC OA RA
59
Carpal Tunnel Syndrome (CTS)
Compression of the median nerve as it passes through the carpal tunnel in the wrist Pain, numbness, and tingling in the thumb, index, middle, and part of the ring fingers Symptoms are often worse at night and can be associated with weakness in hand grip and fine motor tasks
60
De Quervain’s Tenosynovitis
Inflammation of the tendons and their sheaths on the radial side of the wrist, specifically the abductor pollicis longus and extensor pollicis brevis tendons Pain and swelling at the base of the thumb and radial side of the wrist, often aggravated by gripping or pinching activities positive Finkelstein’s test, where pain is elicited when the thumb is grasped and the wrist is ulnarly deviated, is commonly used for diagnosis
61
Radio-Carpal Distraction facilitates:
general motion
62
Radio carpal dorsal glide facilitates:
wrist flexion typically performed with the wrist in a neutral or slight extension position increases the space in the palmar aspect of the wrist joint carpal bones to move more freely and accommodate the bending of the wrist forward
63
Radio carpal volar/palmar glide facilitates:
wrist extension
64
Loose pack position:
wrist in straight line through the radius and third metacarpal with slight ulnar deviation increases the space in the dorsal aspect of the wrist joint carpal bones to move more freely and accommodate the bending of the wrist backward
65
Radio carpal ulnar glide facilitates:
wrist radial deviation increase the range of motion for radial deviation (movement of the wrist toward the thumb side).
66
Carpal Bone Accessory Motion Tests (AMT)
place your index fingers on the volar/palmar surface of the bone to be stabilized. Place the overlapping thumbs on the dorsal surface of the bone to be manipulated. The rest of your fingers hold the patient's hand so it is relaxed. Always mobilize in the palmar direction using the thumbs
67
To increase flexion, mobilize the ____
concave side (rolls and glides palmarly)
68
To increase extension, mobilize the ___
convex side (the roll is dorsal, so the glide is palmar)
69
To increase flexion: Place the stabilizing index fingers under the bone that is _____ Overlap the thumbs and place on the dorsal surface of the bone that is _____ The thumbs provide the manipulating force.
convex (on the volar/palmar surface) concave.
70
Stabilize Convex scaphoid, mobilize concave ____ and ____ in palmar direction
trapezium trapezoid
71
Stabilize Convex capitate, mobilize concave ___ in ____ direction
lunate palmar
72
Stabilize Convex hamate, mobilize concave ____ in palmar direction
triquetrum
73
To increase extension: Place the stabilizing index fingers under the bone that is _____ Overlap the thumbs and place on the dorsal surface of the bone that is ____ The thumbs provide the manipulating force.

concave (on the volar surface) convex
74
Stabilize concave trapezium and trapezoid mobilize convex ___ in palmar direction
scaphoid
75
Stabilize concave lunate mobilize convex ___ in palmar direction
capitate
76
Stabilize concave triquetrum, mobilize convex ___ in palmar direction
hammate
77
Thumb Carpo-Metacarpal Joint (CMC) Distraction:
Applying a pulling force away from the joint surfaces to separate the metacarpal and trapezium bones. Purpose: Increases joint space and can help reduce joint stiffness and improve overall mobility.
78
Thumb Carpo-Metacarpal Joint (CMC) Ulnar Glide:
(Concave Metacarpal on Fixed Trapezium) Applying a force to glide the metacarpal bone ulnarly (toward the little finger) relative to the fixed trapezium Facilitates: Thumb radial abduction and flexion.
79
Thumb Carpo-Metacarpal Joint (CMC) Radial Glide:
(Concave Metacarpal on Fixed Trapezium) Applying a force to glide the metacarpal bone radially (toward the thumb side) relative to the fixed trapezium Facilitates: Thumb ulnar adduction and extension.
80
Thumb Carpo-Metacarpal Joint (CMC) Dorsal Glide:
(Convex Metacarpal on Fixed Trapezium) Applying a force to glide the convex metacarpal bone dorsally (posteriorly) relative to the fixed trapezium Facilitates: Thumb abduction + flexion.
81
Thumb Carpo-Metacarpal Joint (CMC) Palmar (Volar) Glide:
(Convex Metacarpal on Fixed Trapezium) Applying a force to glide the convex metacarpal bone palmarly (anteriorly) relative to the fixed trapezium Facilitates: Thumb adduction + extension.
82
Thumb Carpo-Metacarpal Joint (CMC) Resting position is neutral:
midway between flexion and extension and between abduction and adduction.
83
MCP, PIP and IP joints Resting position is in:
slight flexion for all joints
84
MCP, PIP and IP joints Distraction:
Applying a pulling force away from the joint surfaces to separate the proximal and distal bones Purpose: Increases the joint space, which can help to alleviate joint stiffness and pain
85
MCP, PIP and IP joints Dorsal Glide:
Applying a force to glide the distal bone posteriorly (dorsally) relative to the proximal bone Facilitates: Extension of the joint.
86
MCP, PIP and IP joints Volar (Palmar) Glide:
Applying a force to glide the distal bone anteriorly (volarly) relative to the proximal bone Facilitates: Flexion of the joint.
87
Convex-Proximal Bone, Concave-Distal Bone Dynamics: MCP Joint:
Convex Proximal Bone: Metacarpal head. Concave Distal Bone: Proximal phalanx. Dorsal Glide: Facilitates MCP joint extension. Volar Glide: Facilitates MCP joint flexion.
88
Convex-Proximal Bone, Concave-Distal Bone Dynamics: PIP Joint:
Convex Proximal Bone: Proximal phalanx. Concave Distal Bone: Middle phalanx. Dorsal Glide: Facilitates PIP joint extension. Volar Glide: Facilitates PIP joint flexion.
89
Convex-Proximal Bone, Concave-Distal Bone Dynamics: DIP Joint:
Convex Proximal Bone: Middle phalanx. Concave Distal Bone: Distal phalanx. Dorsal Glide: Facilitates DIP joint extension. Volar Glide: Facilitates DIP joint flexion.
90
Objective examination: Dexterity tests
Jebsen–Taylor Hand-Function Test Nine-Hole Peg Test Purdue Pegboard Test
91
Jebsen–Taylor Hand-Function Test
evaluate a range of hand functions, including fine and gross motor skills ability to perform daily tasks that require hand dexterity, speed, and coordination Poor criterion and discriminant validity with MHQ Small change for CTS; moderate change for RA, OA, Fx
92
Nine-Hole Peg Test
measure dexterity and finger dexterity through timed peg placement and removal assess fine motor skills, hand-eye coordination, and finger dexterity used in neurorehabilitation and occupational therapy to measure changes in hand function
93
Purdue Pegboard Test
evaluate both gross and fine motor dexterity, as well as hand-eye coordination Part 1: Subjects place pegs into the holes using one hand at a time. Part 2: Subjects assemble pegs, washers, and collars onto a pin. evaluate manual dexterity, speed, and coordination
94
Carpal Instability
Multi-link structure – Zigzag effect

Mobile proximal row “intercalated” between 2 rigid structures Can get rotational collapse Lunate most frequently dislocated- can dislocate dorsally (DISI scapholunate instability) or volarly (VISI-lunotriquetral instability)
95
The wrist comprises eight carpal bones, which are organized into two rows: the proximal row ____ and the distal row _____
(scaphoid, lunate, triquetrum, and pisiform) (trapezium, trapezoid, capitate, and hamate)
96
Special tests – Instability
Scaphoid shear test Scaphoid shift or Watson’s test Lunotriquetral ballottement (Reagan’s) test DRUJ instability / piano key test Pivot shift test of midcarpal Thumb ulnar collateral ligament test
97
Scaphoid shear test
Testing for scapholunate instability Lunate and scaphoid are then sheared in a dorsal/palmar directions + signs are laxity and reproduction of pt’s pain
98
Key Concepts in Frontal Plane Carpal Stability
Ulnar Deviation: Movement of the wrist towards the ulnar side (little finger side). Radial Deviation: Movement of the wrist towards the radial side (thumb side). Scaphoid: A major bone in the proximal row that plays a critical role in wrist stability. Lunate: Central carpal bone in the proximal row, significant in maintaining overall carpal alignment. Trapezium and Trapezoid: Distal row bones that articulate with the metacarpals and contribute to stability during wrist movements.
99
Scaphoid shift or Watson’s test
Patient sits with elbow resting on table and forearm in neutral Patient sits with elbow resting on table and forearm in neutral Radially deviate and slightly flex the patient’s wrist + if pain reproduced at dorsal aspect of wrist, and /or clunk is heard/felt, suggesting instability Can be + in 1/3rd of individuals with no problem***
100
Lunotriquetral ballottement (Reagan’s) test
Second most common instability (VISI- lunate tilts ventrally) PT grasps the triquetrum between thumb and index finger of one hand and lunate with the thumb and index finger of the other hand PT moves lunate in a palmar and dorsal direction wrist moved into radial deviation, repeat w/wrist in ulnar deviation + test if reproduces pain, crepitus or excessive motion
101
DRUJ instability / piano key test
Patient sits with both arms in pronation PT stabilizes the patient’s arm with one hand so that PT’s index finger can push down on distal ulna (like in piano) Results compared to the other side Difference in mobility and with pain is + for distal radioulnar joint instability
102
Pivot shift test of midcarpal
Patient is seated with elbow flexed at 90 deg and resting on firm surface and hand fully supinated PT stabilizes the forearm with one hand and with the other hand takes the patient’s hand into full radial deviation with wrist in neutral PT maintains position and patient’s hand is place in full ulnar deviation + if capitate shifts away from lunate indicating injury to anterior capsule and interosseous lig + test if at end ranges, proximal row “clunks” into place
103
Thumb ulnar collateral ligament test
PT applies valgus stress to MCP joint/ UCL Tested at 0 and 30 degrees MCP flexion + test is pain and extreme laxity (>15 degrees angulation as compared to uninvolved side- test opposite side first to get baseline) Risk of Stener lesion- UCL entrapment under adductor pollicus apponeurosis
104
testing at 0 degrees of MCP flexion assesses the ligament's stability under :
the least amount of flexion, which puts the UCL under its maximum tension.
105
testing at 30 degrees of MCP flexion assesses the UCL's stability in :
a more functional and less strained position.
106
Special tests – Instability
TFCC load test Grip dynamometer
107
TFCC load test
PT holds patient’s forearm with one hand and patient’s hand with the other hand PT then axially loads and ulnarly deviates the wrist while moving it dorsally and palmarly or by rotating the forearm If + there is pain, clicking, or crepitus in the area of TFCC
108
Grip dynamometer
in neutral and in pronation + test- strength decreased and + pain when tested in the pronated position
109
Special tests – Stiff, loose, painful – CMC OA
Grind test Bunnell-Littler Test
110
Grind test
PT holds the patient’s hand with one hand and grasps the patient’s thumb below the MCP with the other hand PT applies axial compression and rotation to MCP If with pain, test is + and indicates OA of MCP or metacarpotrapezial joint
111
Key finding for CMC OA =
loss of retroposition joint to move backward or toward the palm, especially during thumb opposition = More flexed position of the thumb
112
Special tests – Painful: tendons and muscles
Finkelstein test Eichhoff’s test WHAT test high sensitivity, low specificity
113
Finkelstein test
Examiner passively pulls the wrist and thumb into ulnar deviation and applies longitudinal traction + test indicates pain over APL and EPB tendons at the wrist tenosynovitis of these tendons Compare with the other side as this is likely to be + even with healthy individuals
114
Eichhoff’s test
Patient makes a fist with thumb inside fingers Examiner stabilizes the forearm and passively moves into ulnar deviation + test indicates pain over APL and EPB tendons at the wrist Compare with the other side as this is likely to be + even with healthy individuals
115
Wrist hyperabduction and abduction of the thumb (WHAT) test
Patient’s wrist is hyperflexed with the thumb abducted (actively moved radially) in full MCP and IP extension Resistance is applied against the examiner’s index finger + test indicates pain over APL and EPB tendons at the wrist
116
Special tests – Painful/paresthesias: nerve entrapment
Tinel’s sign at the wrist > Median or ulnar nerve Phalen’s / wrist flexion test Froment’s sign
117
Tinel’s sign at the wrist: median
PT taps over the carpal tunnel (Median n.) + causes tingling into thumb, index finger, middle and lateral half of ring finger = Carpal tunnel syndrome
118
Tinel’s sign at the wrist: ulnar
PT taps over the Guyon’s tunnel (Ulnar n.) + causes tingling into 4th and 5th fingers Tunnel of Guyon: space between hamate and pisiform
119
Phalen’s / wrist flexion test
Test for CTS PT flexes patient’s wrist maximally and holds for 45-60 sec by pushing wrists together + tingling over median n distribution ((thumb, index finger, middle finger, and half of the ring finger)
120
Froment’s sign
Patient attempts to grasp a piece of paper between thumb and index finger + if terminal phalanx of the thumb flexes because of paralysis of the adductor pollicis If + then ulnar nerve impairment

msk 3 midterm (2 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions