assessment of the wrist and hand Flashcards
CMC/MCP close packed
fist
CMC/MCP loose packed
slight flexion
IP close packed
full extension
IP loose packed
slight flexion
1st CMC capsular
abd > ext
MCP and IP
flexion > extension
scaphoid compression test
sitting with arms relaxed
longitudinal pressure through thumb
+ test reproduction of symptoms
anatomical snuffbox tenderness
sitting with arms relaxed
pressure on snuffbox
+ pain or tenderness during palpation
radial and ulnar styloid
widest projection of wrist
metacarpals
V notches and proximal edges
DRUJ
extensor digiti minimi points to this joint
lister’s tubercle
prominent bump on radius
in line with 2nd MC
scaphoid
anatomical snuffbox
trapezium
between scaphoid and base of 1st MC
trapezoid
between scaphoid and 2nd MC
capitate
divot proximal to 3rd MC
lunate
proximal to capitate, prominent in wrist flexion
hamate
proximal to 4th and 5th MC
triquetrium
proximal to hamate
pisiform
prominent base of ulnar side
FCU points to it
hook of the hamate
between pisiform and 2nd MCP joint, 2cm up
scaphoid tubercle
base of the thenar eminence
FCR points to it
trapezium tubercle
1 cm distal to scaphoid tubercle
protrudes in ulnar dev
capitate
halfway between hook of hamate and trapezium tubercle
lunate
halfway between pisiform and radial styloid
wrist flexion ROM
stationary: ulnar styloid to olecranon
fulcrum: lateral to triquetrium
movement: parallel with 5th MC
0-80
wrist extension ROM
stationary: ulnar styloid to olecranon
fulcrum: lateral to triquetrium
movement: parallel with 5th MC
0-70
wrist ulnar deviation
stationary: lateral epicondyle
fulcrum: capitate
movement: parallel with 3rd MC
0-30
wrist radial deviation
stationary: lateral epicondyle
fulcrum: capitate
movement: parallel with 3rd MC
0-20
2-5 MCP flexion
stationary: dorsal midline of MC
fulcrum: dorsal aspect of MCPJ
movement: dorsal midline of proximal phalanx
90
2-5 PIP flexion
stationary: dorsal midline of prox phalanx
fulcrum: dorsal aspect pf prox IPJ
movement: dorsal midline of middle phalanx
100
2-5 DIP flexion
stationary: dorsal midline of prox phalanx
fulcrum: dorsal aspect pf prox IPJ
movement: dorsal midline of middle phalanx
100
2-5 MCP extension
stationary: palmar midline of MC
fulcrum: palmar aspect of MCPJ
movement: palmar midline of proximal phalanx
45
2-5 PIP extension
stationary: palmar midline of prox phalanx
fulcrum: palmar aspect pf prox IPJ
movement: palmar midline of middle phalanx
0
2-5 DIP extension
stationary: palmar midline of prox phalanx
fulcrum: palmar aspect pf prox IPJ
movement: palmar midline of middle phalanx
10
2-5 MCP abd
stationary: dorsal midline of MC
fulcrum: dorsal aspect MCPJ
movement: dorsal midline of proximal phalanx
20
1st MC flexion
stationary: ventral midline of radius
fulcrum: palmar aspect of 1st CMCJ
movement: ventral midline of 1st MC
find baseline and subtract from final measurement
15 deg
1st MC extension
stationary: ventral midline of radius
fulcrum: palmar aspect of 1st CMCJ
movement: ventral midline of 1st MC
find baseline and subtract from final measurement
15 deg
1st MC abd
stationary: lat midline of 2nd MC
fulcrum: lat aspect of radial styloid
movement: lat midline of 1st MC
70 deg
1st MCP flexion
stationary: dorsal midline of fist MC
fulcrum: dorsum of 1st MCPJ
movement: dorsal midline of proximal phalange
50 deg
1st IP flexion
stationary: dorsal midline of prox phalanx
fulcrum: dorsal surface of IPJ
movement: dorsal midline of distal phalange
80 deg
1st IP extension
stationary: dorsal midline of prox phalanx
fulcrum: dorsal surface of IPJ
movement: dorsal midline of distal phalange
20 deg
wrist flexion 3-5
hand on table
median nerve: pull 1-3 into extension
ulnar nerve: pull 4-5 into extension
wrist extension 3-5
hand on table
pull into flexion
wrist flex/ext 0-2
hand on side
2-5th MCP flexion 3-5
palm up on table
pull into ext
resistance on proximal phalnges
2-5th MCP extension 3-5
palm down on table
make a claw
resistance into flexion on prox phalange
2-5th MCP flex/ext 0-2
hand on side
can they do it?
2-5th MCP abduction 0-5
palm down on table
resistance into adduction
2-5th MCP adduction 0-5
palm down on table
resistance into abduction
2-5th prox IP flexion 3-5
palm up
resistance into extension on middle phalange
2-5th distal ip flexion 3-5
palm up
resistance into extension on distal phalange
2-5th PIP/DIP flexion 0-2
hand on side
can they do it?
1st CMC abduction 0-5
baby shark hand, moth open
resistance into adduction on proximal phalange for brevis
resistance into adduction on metacarpal for longus
1st CMC adduction 0-5
baby shark, mouth closed
resistance into abduction on prox phalanx
1st CMC opposition 0-5
thumb and pinky together
pull thumb and pinky apart at MCs
1st MCP flexion 0-5
palm up
resistance into extension on proximal phalanx
1st MCP extension 0-5
palm up
resistance into flexion on proximal phalanx
1st IP flexion 0-5
palm up
resistance into extension on distal phalanx
1st IP extension 0-5
palm up
resistance into flexion on distal phalanx
wrist posterior (dorsal) glide
pt hand to side
PT palms down on either side of joint
push pt hand posterior
helps flexion
wrist anterior (palmar) glide
pt hand to side
PT palms down on either side of joint
push pt hand anterior
helps extension
wrist ulnar glide
pt palm up
PT palms down on either side of joint
push pt hand ulnarly
helps radial deviation
wrist radial glide
pt palm up
PT palms down on either side of joint
push pt hand radially
helps ulnar deviation
specific carpal bone posterior glide
pt hand off table
push carpal downward
trapeziometacarpal joint posterior glide
push 1st MC backwards
carpometacarpal joints 2-5 posterior glide
pt palm down
push MC up
MCP joints 1-5 glides
pt palm down
push proximal phalanx up
IP joints 1-5 glides
pt palm down
push distal phalanx up
ulnar collateral ligament test
valgus at thumb
+ movement greater than 30 deg
watson scaphoid test
push on scap, into ulnar dev, let go
push on scap, into radial dev, let go
+ clunking sound when letting go
ulnomeniscotriquetral dorsal glide
thumb on ulna, index finger on pisiform
dorsal glide on pisiform by squeeing thumb and index