Elbow, Forearm, Wrist and Hand Examination Flashcards
INTRO AND VISUAL INSPECTION
INTRO AND VISUAL INSPECTION
Screening questions done during the patient interview?
- UE Trauma; specify mechanism
- Hx neck pain/trauma
- Hx shoulder pain/trauma
- UE paresthesia, anesthesia, weakness
- Screening for other non-musculoskeletal health conditions or MSK conditions where referral is indicated
Common functional limitations present present during the patient interview?
- Gripping/lifting
- Eating
- Pushing/pulling
- Typing
- Catching/throwing
- w/b through UE
Outcome measures used for UE during patient interview?
- PSFS
- QuickDASH
What do we look for during our visual inspection?
- Gross abnormalities (local swelling/redness, deformity, atrophy)
- Integumentary
- Resting posture vs ability to correct
- Posture assessment
With posture visual inspection we are looking at what structures?
- Head on neck
- Mandible on cranium
- Neck on trunk
- Scapulae on thorax
- Upper arms on scapulae (rotation)
- Carrying angle
- Resting flexion angle of elbow
- Resting position of supination/pronation at the forearm
- Resting position of hand
Systems review purpose?
Identify things we need to look into further.
ELIMINATION TESTS
ELIMINATION TESTS
What are the parts of eliminations tests?
- UQS
- Neuro Screening Tests (light touch, pin prick, myotome, DTRs, Long Track Signs)
- Special Tests
With our elimination tests, we should think about tests that could ____ _____ more proximal contributors.
rule out
What are some conditions that we can apply elimination tests to at the elbow/forearm?
- Cubital Tunnel Syndrome
- Fracture at Elbow
- Biceps Tear
- Elbow Instability
What test(s) are used to rule out Cubital Tunnel Syndrome?
Pressure Provocation Test
What test(s) are used to rule out Fracture at the Elbow?
-Elbow Extension, Flexion, Supination, Pronation Tests
What test(s) are used to rule out Biceps Tear?
Biceps Squeeze Test
What test(s) are used to rule out Elbow Instability?
- Moving Valgus Stress Test
- Varus Stress Test (LCL)
- Valgus Stress Test (MCL)
What are some conditions that we can apply elimination tests to at the wrist/hand?
- Thumb Instability
- DeQuervain’s Tenosynovitis
- Scaphoid Fracture
What test(s) are used to rule out Thumb Instability?
Ulnar Collateral Ligament Test
What test(s) are used to rule out DeQuervain’s Tenosynovitis?
Finkelstein’s Test
What test(s) are used to rule out Scaphoid Fracture?
Anatomical Snuffbox Tenderness
Neurodynamic Tension Testing:
- What is done prior to the test?
- What indicated a positive test?
Prior to test:
- check base-line symptoms
- demonstrate desired active sensitization motions
- clear instructions
Positive test:
- concordant symptom reproduction
- response altered by movement of distant body part
- test difference with laterality
What is the order of the Median Nerve Bias Neurodynamic Tension Testing components?
- Scapular depression
- Shoulder adduction to 110 degrees
- Forearm supination
- Wrist/hand extension
- Shoulder ER
- Elbow Extension
- Sensitization maneuver
What is the order of the Radial Nerve Bias Neurodynamic Tension Testing components?
- Scapular depression
- Forearm pronation
- Elbow extension
- Wrist and finger flexion
- Shoulder IR
- Shoulder slight extension
- Shoulder abduction
- Sensitization maneuver
What is the order of the Ulnar Nerve Bias Neurodynamic Tension Testing components?
- Scapular depression
- Shoulder abduction to 110 degrees
- Shoulder ER
- Elbow flexed
- Forearm pronation
- Wrist/hand extension
- Sensitization maneuver
STRUCTURAL STRESS TESTING
STRUCTURAL STRESS TESTING
Structural Stress Testing involves what 3 components?
- AROM
- PROM
- Resistive Testing
What movements do we want to assess during our Structural Stress Testing?
- Elbow Flexion/Extension
- Elbow Supination/Pronation
- Wrist Flexion/Extension
- Wrist Abduction/Adduction
- MCP Flexion/Extension
- IP Flexion/Extension
- CMC Flexion/Extension/ABD/ADD/Opposition/Reposition
PALPATION AND JOINT MOBILITY TESTING
PALPATION AND JOINT MOBILITY TESTING
What joint mobility can be performed at the Humero-Ulnar Joint?
Posterior
What joint mobility can be performed at the Humero-Radial Joint?
- Anterior
- Posterior
What joint mobility can be performed at the Proximal Radio-Ulnar Joint?
- Anterior
- Posterior
What joint mobility can be performed at the Distal Radio-Ulnar Joint?
- Anterior
- Posterior
What joint mobility can be performed at the Radiocarpal Joint?
- Ventral
- Dorsal
- Radial
- Ulnar
What joint mobility can be performed at the CMC?
- Palmar
- Dorsal
- Radial
- Ulnar
What joint mobility can be performed at the MCP, PIP, DIP?
- Palmar
- Dorsal
CONFIRMATION TESTS
CONFIRMATION TESTS
What confirmation test(s) can be used to rule in Cubital Tunnel Syndrome?
- Elbow Flexion Test
- Tinel’s Sign
What confirmation test(s) can be used to rule in Lateral Epicondylopathy?
- Cozen’s Test
- Resisted Tennis Elbow Test
- Passive Tennis Elbow Test
What confirmation test(s) can be used to rule in Carpal Tunnel Syndrome?
- Phalen’s Test
- Tinel’s Test
- Median Nerve Compression Test
What is a good performance measure for grip strength?
Jamar Hand Dynamometer
