Elbow, wrist, and hand Flashcards
radial head TP: location
anterolateral part of radial head
radial head TP: treatment
- patient supine
- physician seated facing patient
- patient’s elbow fully flexed and forearm pronated until palm is facing forward
- humerus internally rotated by taking forearm medially so that the back of the patient’s hand approximates chest
- follow steps of C/CS
coronoid TP: location
either side of coronoid process of ulna on either side of biceps tendon
coronoid TP: treatment
- patient supine
- physician seated facing patient
- elbow markedly flexed
- forearm is pronated until the palm is forward
- forearm is taken laterally to cause external rotation of humerus
- follow steps of C/CS
anterior interosseus TP: location
anterior aspect of proximal to middle 1/3 of forearm in midline
anterior interosseus TP: treatment
- patient supine
- physician seated facing patient
- forearm fully supinated
- elbow markedly flexed
- wrist fully flexed
- fine tune with further supination or pronation
- follow steps of C/CS
medial / lateral olecranon TP: location
on either side of olecranon process of ulna
medial / lateral olecranon TP: treatment
- patient supine
- physician seated facing patient
- elbow extended and arm just distal to elbow resting on physician’s knee, causing mild hyperextension
- take forearm into supination and slight abduction or adduction to fine tune
- follow steps of C/CS
thumb TP: location
palmar surface of hand, distal to proximal end of first metcarpal bone on thenar eminence side of palm
thumb TP: treatment
- patient supine
- physician seated facing patient
- approximate patient’s thumb to the palm of patient’s hand
- flexion - flex first MCP
- rotation - internally or externally rotate thumb to find point of maximum comfort
- fine tune with adduction
- follow steps of C/CS
what are the steps of the osteopathic structural exam for the elbow, wrist, and hand?
- diagnose radial head
- diagnose distal radio-ulnar joint
- diagnose MCP, PIP, DIP
- diagnose first MCP restriction , carpal restriction (and/or CTS)
what is indicated by the ability to touch tips of thumbs to each of the other finger tips?
radial, median, and ulnar nerves are intact
anterior radial head ME
- patient supine
- physician monitors radial head between thumb and index finger of one hand
- physician takes patient’s forearm into pronation to a barrier
- patient attempts to supinate forearm against physician’s resistance
- physician takes patient’s forearm farther into pronation to 4th barrier
6 recheck
posterior radial head ME
- patient supine
- physician monitors radial head between thumb and index finger
- physician takes patient’s forearm into supination to a barrier
- patient attempts to pronate forearm against physician’s resistance
- physician takes patient’s forearm farther into supination to 4th barrier
- recheck
anterior radial head correction: HVLA
- patient supine
- physician stands or sits on affected side of patient and places two fingers anterior to radial head
- physician fully flexes patient’s pronated forearm to a barrier
- physician gives quick HVLA thrust by approximating forearm toward shoulder - brings radial head posteriorly
- recheck for symmetry
posterior radial head correction: HVLA
- patient supine
- physician stand or sits on affected side
- physician stabilizes patient’s wrist in one hand to maintain arm extension
- physician controls elbow with fingers on antecubital fossa and thumb on posterior aspect of radial head - patient’s humerus is internally rotated so that anterior portion of arm faces medially
- patient’s arm fully supinated and elbow is placed in exension
- an anteriorly directed HVLA thrust directed toward patient’s midline is made by physician’s thumb to articular the radial head (short distance)
- recheck for symmetry
radial head SD correction with ROM
- patient supine
- physician sits on table between patient’s arm and body
- patient’s arm placed across physician’s thigh, which acts as fulcrum
- physician’s thumb is placed over anterior aspect of the radial head and index / middle fingers placed on posterior aspect of radial head
- physician’s other hand grasps the patient’s supinated wrist
- while monitoring radial head, physician moves forearm into pronation and full elbow flexion, then through circumduction and into supination and extension
- recheck for symmetry
mobilization of distal radioulnar joint
- patient supine
- with patient’s forearm in pronation, physician holds distal end of radius and ulna with both hands and resists the patient’s efforts in supination of the forearm - applied to 4th barrier
- repeat procedure in supination, as patient tried to take forearm into pronation - to 4th barrier
- mobilizes distal radioulnar articulation and helps to decongest forearm
- recheck for symmetry
when is mobilization of distal radioulnar joint contraindicated?
positive piano key sign
reduction of partial dislocation of radial head
- rule out fracture or full dislocation
- patient supine
- physician cups elbow with one hand while holding radial head with thumb and index finger
- physician’s other hand holds distal end of the radius by extending wrist
- using compression, forearm is taken into pronation and supination as one would “chalk a cue stick”
- recheck by reevaluating radial head motion and/or pain free active ROM of elbow / forearm
twisting / wringing of the arm and forearm
- patient supine
- physician initially stabilizes patient’s UE by firmly holding elbow between arm and thorax
- physician places both hands on patient’s arm and moves them as if “wringing out a towel”
