Arm , Elbow , Wrist Flashcards
Elbow Flexion
70
Elbow extension
0-5
Pronation
80-90
Supination
90
Elbow flexor
Biceps brachii
Brachialis
Brachioradialis
Flexor carpi radialis ( assist) ulnaris ( assist)
Palmaris longus (assist)
Pronator teres ( assist)
Extensor carpi radialis longus , brevis ( assist)
Elbow extensor
Tricep brachii (all heads) Anconeus
Forearm supinator
Biceps brachii
Supinator
Brachioradialis ( assist)
Forearm pronator
Pronator teres
Pronator qaudratus
Brachioradialis ( assist)
Wrist flexion
75-90
Wrist extension
70-90
Abduction ( radial flexion )
15-25
Adduction( ulnar flexion)
20-35
Extension of the wrist
Extensor carpi radialis longus , Brevis Extensor carpi ulnaris Ext digitorum ( assist) indicis( assist)
Flexion of the wrist
Flexor carpi radialis, ulnaris
Palmaris longus
Flexor digitorum superficialis , profundus (assist)
Flexor pollicis longus
Abduction of he wrist ( radial deviation)
Extensor carpi radialis longus, brevis
Extensor pollicis longus, brevis
Flexor carpi radialis
Abductor pollicis longus
Adduction ( ulnar deviation)
Extensor carpi ulnaris ,
Flexor carpi ulnaris
Flexion of the thumb
Flexor pollicis longus, brevis Adductor pollicis ( assist) Palmar interossei
Extension of the thumb
Extensor pollicis longus, brevis Abductor pollicis longus Palmar interossei(1st assist)
Opposition of the thumb
Opponens pollicis
flexor pollicis brevis (assist)
Abductor pollicis brevis( assist)
Abduction of the thumb
Abductor pollicis longus, brevis
Adduction of thr thumb
Adductor pollicis
Palmar interossei
Degree of Dupuytren’s Contracture
Record flexion contractores found in dupuytrens contracture
1: add degree of AF at MCP , Prox ITP and Distal ITP of each affected digit , this will give a total number of degree of flexion deformity for each finger
Stages
0- no flexion deformity , only thickening of palmar fascia and nodules are present
1- 0-45 most occur MCP
2- 45-90 at MCP
3-90-115 including Distal ITP
4- greater than 135 terminal phalanges become Hyperextend , while other are flexed
Phalen’s test
P- presence of Carpal tunnel or compression of median nerve
Clt
1: seated
2: instruct client put Back hand Together , wrist flex , elbow held horizontally , shoulder are not elevated
3: ask client to strongly compress the back of hand together 1 minute ( this produce maximum compress within carpal tunnel )
+ = tingling reported in thumb , index finger , middle finger and lateral half of the ring finger is positive for carpal tunnel
Reverse Phalen’s
Variation on Phalen
1: put palms of hands together and to strongly compress the palms together for 1 minute
Cyriax , variation on Phalens test
Asses for presence of carpal tunel syndrome
1: place hands as Phalens
2: variation , After full 1 minute of bilateral wrist hyperextension
3: instruct clt to sudden add wrist extension
+ = reproduction clt symptom
Finger flexion test
Asses presence Trp on Scalene mm group
1: seated
2: instruct clt to hold MCP joint of affected side in ful extension throughout the test
3: instruct clt to flex ITP joint attempting to touch fingertips to palmar surface ( do not let clt make a fist)
+ = four fingertips cannot touch mcp , Trp scalene
Variation Trp in Extensor digitorum will presence full index finger flexion only
Finkelstein’s Test
Detemine presence of deQuervain ‘s tenosyvitis
1: seated
2: clt make fist of affected hand
3: thumb firlmly held in flexion inside flexed fingers
4: stabilize the arm proximal to clt wrist with one hand
+ pain along abductor pollicis longus and extensor policis brevis at wrist is positive for tenosynovitis
Because this test can be painful even if tendinitis is not present , perform bilaterally , comoaring affected and unaffected
Variations; clt ulnar deviate wrist , keeping thumb and fingers flexed in a fist as in the first version
+ = pain along tendon sheaths is positive
Froment’s Sign
Asses ulnar nerve lesion
1: instruct clt to grasp piece of paper btw extended thumb and index finger
2: try pull paper away from clt
+ positive adductor pollicis weakenss or paralysis will allow ternimal phalax of the client thumb to flex
Wrist extension Ligamentous Stress test , PR
Asses: sprain of Palmar wrist ligamentous or strain of wrist flexor mm
1: seated with Affected hand in pronation
2: stabilize clt hand proximal to wrist with one hand
3: place other hand agaisnt clt affected hand so two palm are in opposition
3:Passively mve clt wrist into Extension , apply over pressure at end range
+ pain and hypermobility at joint are positive for sprain of palmar radiocarpal ligament
+ pain along flexor mm or tendon is positive for strain , mm spasm end feel maybe present with subacute strain
+ pain dyesthesia into palm and from wrsit proximally along the flexor surface may indicate cts
+ pain on PR wrsit extension on dorsal surface of the joint mat indicate extensor tenosynovitis
Wrist flexion Ligamentous stress Test , PR
Asses sprain of dorsal wrist lig or strain of wrist extensors
1: seated
2: pronate clt affected hand and stabilize proximal to the wrist
3: with other hand , passively flex clt wrist with over pressure at end range
+ pain hypermobility at joint are positivevfor sprain of dorsal radiocapal lig
+ pain extensor on mm or tendon is positive for strain
+ pain with dyesthesis palm wrist proximally along flexor may indicate cts
Radial Ligamentous Stress Test , PR
Asses sprain of ulnar collateral ligament or strain of wrist adductor mm
1: seated affected hand supination
2: stabilize proximal wrist with one hand
3: passive movements affected hand into Radial deviation with over pressure at end range
+ pain and hypermobility at joint positive for sprain of ulnar collateral lig
+ pain local to extensor carpi ulnaris or flexor carpi ulnaris mm tendon is positive for strain of either of these mm
Mm spasm may present with subacute strain
Ulnar ligamentous stress test PR
Asses sprain for sprain of the radial collateral ligament or strain of wrist abductor mm
Mills test
Asses tendinosis of the common extensor tendons
1: seated
2: Passively flex the client wrist with elbow extended
+ pain local to the cet
Reverse Mill test
Asses CFT
1: seated
2: passively extend wrist with elbow in extension
Extensor tendinosis test( Cozen test
Asses for tendinosis
1: seated
2: elbow extend , wrist pronate , slight extension
3:Instruct clt hold this position
4: attempt to flex the wrist
To isolate Extensor Carpi radialis Brevis which often extensor tendonisis pain
1: seated in fromt of table
2: instruct clt lean forwrad fully flex elbow resting forearm on table , test proceeeds ax above clt resting wrist flexion
Flexor Tendinosis test
Asses tendinosis
1: seated, elbow extension , supinate slight flexion
2: instruct to hold
3: attp to extend wrist
+ pain in common flexor tendon and weakenss positive for tendinosis
Abductor pollicis Brevis Strength test AR
Asses strength abductor pollicis brevis
Attemp adduct clt abduction of thumb
