cervical to philanges ortho exam (includes wrist/hand special tests and clnical signficiance things) Flashcards
Cervical Soft Tissue Palpations (7)
- SCM
- Upper Traps
- Middle Traps
- Levator Scap
- Rhomboids (on neck)
- Paraspinals & Extensors (occiput to T3)
- Suboccipitals
Clinical Significance: Upper traps
Common to have dysfunction here for neck pain pts
Associated with forward head posture
Can get trigger points easily
Clinical Significance: suboccipitals
can become really tight with a forward head posture
When tight they trigger head aches
They can be tender so it is good to palpate
Movements of SCM (2)
Contralateral rotation
Ipsilateral flexion
Most muscles, what to palpate for
defects and tenderness
Pain, tenderness, trigger points
Rhomboid major attachments
- Spinous processes of T2-T5
- Lateral scapular spine to inferior angle
Rhomboid Major/Minor (Attachments)
Medial border of scapula to cervical and
upper thoracic spinous processes (C7-T5)
Normative ROM for C-spine
Flex: 50
Ext: 60
Lat Flex: 45
Rotation: 80
C-Spine goiniometry: Saggital plane
Flexion 50 degrees
Extension 60 degrees
C-Spine goiniometry: Frontal plane
Lateral flexion: 45 degrees
C-Spine goiniometry: Transverse
Rotation 80 degrees each way
Three Cervical Manual Muscle Tests
Combined Flexion
Combined Extension
Rotation (primarily tests SCM)
VEOS
Valgus Extension Overload Syndrome.
compression stress on radial side of elbow, distraction stress on medial side. Overhead extension movements - overhead athletes
OCD
Osteocondritis Dessicans
Valgus extension overload syndrome (elbow)
a circular effect with tensile stress along the medial restraint, shear stress in the posterior compartment and compression stress laterally
Can result in UCL tear OCDs etc
cyriax muscle-tendon unit tests
- AROM: painful
- Resisted at midrange: more painful
- PROM: extension painful (but doesn’t have to be as much)
Elbow Special non-neuro Test types (4 types)
- Cyriax Tests
- Valgus & Varus (0, 30)
- Milking Tests (test for VEOS)
- Radiocapitular Compression Test (check for crepitus, clunking, grating, pain —– indicates OCDs at joint).
Special Tests Elbow, Neural
- Tinel’s Sign (median, ulnar, radial n.) - looking for replication of symptoms
- Pronator Teres Syndrome Test - entrapment of Anterior Interosseous nerve - perform 3 times
Cyriax Tests for the elbow (2)
Cyriax Tests
- Wrist flexors
- Wrist extensors
Valgus/Varus tests for elbow
Valgus & Varus (0, 30)
- 0 degrees
- 30 degrees
Milking Tests
Milking Tests (test for VEOS)
- Milking Test (120 degrees)
- Modified (70 degrees)
- Dynamic (120 - 70 degrees)
Radiocapitular Compression Test
Radiocapitular Compression Test
- axial load with RD, palpate radial head
- Add Pronation 3 times
- Add Supination 3 times
DDD Version
- go 90-extension in Pronation
- go 90-extension in Supination
The UCL tests and the radiocapitular tests are all designed to check for _________.
VEOS (Valgus Extension Overload Syndrome)
All Elbow Special Tests (6)
- Cyriax
- Valgus/Varus
- Milking
- Radiocapitular Compression 5. Tinel’s Sign
- Pronator Teres Syndrome Test
Boxer’s fracture
fourth or fifth metacarpal fracture because there is more mobility in those metacarpals
palpate CMC joints, common problem here
arthritis will often cause pain here
Philanges palpation
- PIP (pain instability)
- DIP (pain, mobility)
- Bouchard’s nodes
- Heberden’s Nodes
Bouchard’s Nodes
Enlargement at PIP from RA
Heberden’s nodes
enlargement at DIP from osteoarthritis
feel for ____ in palmar facia
nodules
tufts of fingers
part of observation/palpation
Finger & thumb Special Tests: Stability (4)
- Axial Load (finger/thumb)
- Grind Test (thumb)
- Thumb UCL (0, slight flexion)
- Collateral Ligaments of Fingers
Finger/Thumb Special Tests, Musculotendinous: (3)
- Finkelstein Test - 1st tunnel
- Sweater/Jersey Finger - Flexor Digitorum profundus
- Mallet Finger - Extensor Digitorum Communis
Hand Special Tests, Circulation: (2)
- Allen’s Test - compress radial and ulnar arteries at wrist while flexing hand 10 times, let one go, observe refill. Repeat but let other one go.
- Digital Bloodflow (same as capillary refill)
Hand neurological Special tests: (6)
- Tinnel’s (carpal tun - median; Guyon’s tun - ulnar)
- Phalen’s (reverse prayer - median)
- Froment’s Sign (paper pinch - ulnar nerve, AdP)
- OK Sign (median - FPL & FDP)
- Semmes Weinstein (filament)
- Weber’s two point discrimination test (paperclip)
Three best tests for Carpal Tunnel
- Tinel
- Phalen
- Semmes Weinstein
Weber’s Two point discrimination Test norm
6mm
Do on nerve distribution
Deformity in swan neck deformity?
flexion MCP and DIP,
extension of PIP
Boutonniere deformity is a?
finger joint deformity -PIP flexion with DIP hyperextension
from RA
Murphy’s sign
dislocation of the lunate. make a fist; veiw knuckles.
As the examiner, visually inspect the dorsal aspect of the hand. Normally the knuckle formed by the head of the third metacarpal is more prominent and protrudes further distally as compared to the knuckles of the second and fourth metacarpal heads. If the knuckle of the third metacarpal head is level with the knuckles of the second and fourth metacarpal heads, the sign is positive and indicative of a lunate dislocation.
Clinical significance of tunnel one (2):
- senosing tenosynovitis
- DeQuervain’s Syndrome
Clincal Significance of Tunnel 4
If pt has RA, tendons can develop cysts and rupture.
Tendons are Extensor Digitorum Communis and Extensor Indicis
Clinical significance of tunnel 6
this tendon commonly ruptures if there is a colles fracture
(extensor carpi ulnaris is in this tunnel)
Wrist Special Tests (4)
- Lunotriquetrum Ballottement test
- Murphey’s Sign - fist with 3rd dropped
- Watson’s Test, (scaphoid fracture) palpate scaphoid and PROM flex and RD - ext and UD
- Scaphoid Stress Test - (scaphoid fracture) palpate scaphoid and AROM flex and RD - ext andUD
