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Extremity Adjusting > Elbow, Wrist, and Hand Q and A's Gindl > Flashcards

Elbow, Wrist, and Hand Q and A's Gindl Flashcards

1
Q

Test to check for patency of the radial and ulnar arteries

A

Allen’s Test

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2
Q

Positive Allen’s Test

-What does it indicate?

A

Delay in refill of the hand

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3
Q

Possible causes of a positive Allen’s

A
  • Subluxation
  • Reynaud’s
  • Old fractures
  • Scar tissue
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4
Q

Positives for Finkelstein’s

-What do they indicate?

A

1) Unable to bring the thumb across and/or muscle wasting
- Ulnar nerve palsy
2) Pain along the radial side of the forearm
- Stenosing Tenosynovitis of DeQuervain

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5
Q

What would be a DDx for a positive Finkelstein’s?

A
  • Scaphoid fracture
  • Stenosing Tenosynovitis of DeQuervain
  • Carpal subluxation
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6
Q

Treatment if someone has a positive Finkelsteins

A

Ice and biomechanical correction

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7
Q

What tendons make up the tunnel of DeQuervain?

A
  • Extensor pollicis brevis
  • Abductor pollicis longus
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8
Q

What are some causes of ulnar nerve palsy?

A

Trauma to the ulnar nerve (banged it or compressed it) or elbow subluxation

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9
Q

Positive Froment’s Test

-Indications?

A

Patient’s thumb flexes in order to hang onto the paper.

-Ulnar nerve palsy. By flexing the thumb, the patient recruits the median nerve in order to hang on to the paper

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10
Q

Most important thing to do for Froment’s during a practical

-What ways can verify Froment’s?

A

Dr. should make sure that they could visualize the patient’s thumb. They must be able to see if the patient flexes the thumb

-Look for thenar or hypothenar muscle wasting; loss of strength in muscle tests; EMG

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11
Q

English Test

  • Positive _____
  • Indication ______
A

Occlude the arteries before pumping the hand and hold for 60 seconds.

  • Symptoms of carpal tunnel emerge
  • Carpal Tunnel Syndrome
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12
Q

Two reasons why English Test works

A

1) Hypoxia
2) Pooling of the blood around the carpal tunnel increases pressure on the Median nerve

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13
Q

Orthopedic Tests for Carpal Tunnel Syndrome

A
  • English
  • Phalen’s
  • Tinel Tap
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14
Q

DDx for Carpal Tunnel Syndrome

A
  • Cervical subluxations
  • Pronator teres syndrome
  • Elbow subluxation
  • Shoulder subluxation
  • TOS
  • Reynaud’s
  • Tenosynovitis of DeQuervain
  • Ulnar/Radial nerve palsy
  • Fractures
  • Trigger points on the thumb for the stomach and liver
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15
Q

Carpal Tunnel Syndrome signs/symptoms

A
  • Pain
  • Paresthesia
  • Numbness
  • Tingling

(Median Nerve distribution)

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16
Q

What is the length of time for performing English Test?

A

Hold for up to a minute or if carpal tunnel symptoms appear before the minute is up

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17
Q

Name two tests that could verify a positive Tinel Tap at the wrist

A
  • Phalen’s
  • English
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18
Q

What is the direction of carpal misalignment in carpal tunnel syndrome?

A

Anterior lunate

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19
Q

Is the lunate usually hypomobile or hypermobile in someone with carpal tunnel?

A

Hyper mobile

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20
Q

What makes up the carpal tunnel?

A

The lunate at the posterior aspect and the transverse carpal ligament at the anterior aspect

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21
Q

What are the contents of the carpal tunnel?

A

Nine flexor tendons

Median Nerve

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22
Q

The adjusting move of choice for someone with carpal tunnel syndrome

A

Wrist traction

-FLEXION ONLY (extension would push lunate anterior and aggrevate the symptoms)

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23
Q

Best carpal tunnel post check

A

Repeat orthopedics that were positive on the precheck

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24
Q

Which carpal tunnel test would you not due as a postcheck and why?

A

Reverse Phalen’s

-Pushes the lunate anterior

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25
Q

What would you do after treating carpal tunnel syndrome?

A

After adjusting for lunate anterior, bracre or support the wrist then strengthening exercises

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26
Q

What procedures should the Dr. perform to help DDx with a positive Cozen’s or Mill’s test?

A
  • Palpate for point tenderness
  • Palpate to differentiate whether the pain is over the raidal head or lateral epicondyle
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27
Q

What treatment protocol would you perform for a lateral epicondylitis?

A

Correct any biomechanical dysfunction, ice the swelling, wear a counter-fore armband, and change activites for the elbow as this alters the fulcrum for extension so it’s not directly over the lateral epicondyle

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28
Q

Positives for Cozen’s, Mill’s, Lift Test in Pronation

-What does this indicate?

A

Positive = pain over the lateral epicondyle

-Indicates lateral epicondylitis

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29
Q

Positive finding for lift test in Supination

-What does it indicate?

A

Pain over the medial epicondyle

-Medial epicondylitis

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30
Q

What else could give a positive Lift test besides epicondylitis?

A

Lift test with pronation = Radius Posterior

Lift test with supination = Ulna Posterior or Ulna Posterior Medial

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31
Q

Positive Adson’s

  • What does it indicate?
  • How long do you palpate the radial artery?
A

Decrease in radial pulse amplitude (or abscence of radial pulse)

  • Scanlenus Anticus Syndrome (pressure on subclavian artery and brachial plexus)
  • 10 to 20 seconds
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32
Q

Positive Eden’s

-What does it indicate?

A

Decrease in radial pulse amplitude (or abscence)

-Costoclavicular syndrome (TOS)

33
Q

Positive Wright’s

-What does it indicate?

A

Decrease in radial pulse amplitude (or absence of radial pulse)

-Hyperabduction Syndrome (TOS)

34
Q

Which 3 subluxations would elbow traction work well for?

A
  • Ulna P
  • Ulna PM
  • Radius P
35
Q

What subluxation would elbow traction be the most effective for?

36
Q

How would you post check elbow traction?

A

Check the fluid motion that was lost in the pre-check; look for diminished pain point; and improved elbow extension ROM

37
Q

When adjusting elbow subluxations, when would you supinate and when would you pronate?

A

Supinate = Ulna P and PM

Pronate = Radius P

38
Q

What is the CP for Radius P

A

Tip of the thumb

39
Q

What ROMs are utilized during the Radius P procedure?

A

Full extension and full pronation

40
Q

What is the pain point for Radius P?

A

Right over the head of radius

41
Q

What is the DDx for Radius P?

A
  • Lateral Epicondylitis
  • Cervical Subluxation (C5-C6)
42
Q

What ROM is decreased with Radius P?

43
Q

What subluxation might mimic the symptoms of lateral epicondylitis?

44
Q

What is the pain point for Ulna P?

A

1-1.5” distal to the medial epicondyle

45
Q

What ROMs are utilized during the Ulna PM procedure?

A

Extension and supination

46
Q

What is the pain point for Ulna PM?

A

Olecranon fossa

47
Q

What is the major LOD for Ulna PM?

A

P-A even though the DS and SCP are on the medial side of the arm

48
Q

What is the most common direction for the carpals to misalign?

49
Q

What is the best post check for wrist traction?

A

Fluid motion between the carpals that were adjusted

50
Q

Where is the pain point for wrist traction?

A

Right over the carpal that is misaligned

51
Q

What are your stabilization hand fingers stabilizing during capitate STH?

A

The proximal row of carpals

52
Q

What ROM do you take the patients hand through when performing Scaphoid DTH?

A

Extension and Radial deviation

53
Q

What carpals do you test the scaphoid against for fluid motion?

A

Trapezium, Trapazoid, and Lunate

54
Q

DDx for Trapezium-Scaphoid subluxation

A
  • Scaphoid fracture
  • DJD
  • Stenosing Tenosynovitis of DeQuervain
  • Subluxation(s) of scaphoid-lunate, trapezium-1st metacarpal
55
Q

How would you differentiate the conditions in the previous DDx?

A

Subluxations = fluid motion, check pain points, utilize information from the case history, and X-ray

DJD = check X-rays and perform lab test to determine type of arthritide

Stenosing = Finkelstein’s

Scaphoid fracture = X-ray, wait 10 days and X-ray again

56
Q

What is the difference between DJD and arthritis?

A

Arthritis has inflammation; therefore you’d want to deal with any swelling before adjusting to improve motion

57
Q

What should be ruled out before adjusting a scaphoid?

A

Scaphoid fracture, Radial styloid fracture, stenosing tenosynovitis of DeQuervain, other carpal subluxations

58
Q

Name the wrist procedure from least invasive to most invasive

A
  • Wrist traction
  • STH

DTH

59
Q

T/F The lunate usually misaligns anterior

A

FALSE

  • It usually misaligns POSTERIOR
  • In someone with carpal tunnel syndrome, it usually misaligns ANTERIOR
60
Q

What carpal bone is the MC subluxated?

  • 2nd MC?
  • 3rd MC?
A

MC = Lunate

2nd MC = Capitate

3rd MC = Scaphoid

61
Q

T/F Lunate posterior will be hypomobile usually

A

True

Lunate anterior = Hypermobile (Carpal Tunnel)

62
Q

Describe the wrist traction procedure for carpal tunnel syndrome?

A

Traction S-I

Flex

Return to neutral (no thrust and no extension)

63
Q

Describe the wrist traction maneuver for subluxation of a carpal

A

Traction S-I

Flex

Extend

Return to neutral

Release

64
Q

What would be the move of choice when fluid motion is lost between the scaphoid and lunate?

A

Wrist Traction (transverse/horizontal)

-Then STH, then DTH

65
Q

What is it very important to be sure of when performing the scaphoid DTH?

A

That all fingers are stabilizing the carpals around the scaphoid

66
Q

What stabilizes the radius during Scaphoid DTH?

A

Patients’ own body weight

67
Q

How would you perform wrist traction with a hypermobile anterior lunate?

A

Traction S-I

Flex

Return to Neutral

(DO NOT EXTEND)

68
Q

Where is the pain point for C-MC joints?

A

Right over the joint

69
Q

What direction does the 2nd C-MC subluxated?

A

Rotationally

70
Q

How can a 1st metacarpal subluxation be identified?

A

Loss of fluid motion (P-A)

Point tenderness at C-MC joint

Case history of a jammed thumb

71
Q

Which ROM is most prevalent at the C-MC joint?

72
Q

What are some DDx for C-MC 1st subluxation?

A

Scaphoid subluxation

Scaphoid fracture

Trapezium fracture

Stenosing Tenosynovitis of DeQuervain

Median Nerve disturbance

73
Q

What is the best way to post check the 2nd C-MC?

A

Fluid motion

74
Q

Which C-MC joint (besides 1st) would be the most mobile?

75
Q

How would you determine a C-MC 2-5 subluxation?

A

Stabilize the distal row of carpals and rotate each metacarpal (relative to its adjacent metacarpal) to see if they have fluid motion.

  • Pain over the C-MC joint space
  • A case history with possibly a blow to the area, use of power tools, area was stepped on, a cast was recently removed, etc.
76
Q

What are the normal ROMs for MC-P and I-P joints in the hand?

A

They should have glide from P-A/A-P as well as rotation

77
Q

What type of joint pathologies would you perform MC-P and I-P traction for?

A

You would adjust the MC-P and I-P joints with traction for MC-P/I-P subluxation, jammed fingers, arthritic fingers, DJD, etc.

78
Q

What types of joint pathologies are MC-P and I-P traction good for?

A

Any joint fixation, subluxation, or dislocation, jammed finger, arthritides, DJD

Extremity Adjusting (5 decks)

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