English Test - Positive _____ - Indication ______

Occlude the arteries before pumping the hand and hold for 60 seconds. - Symptoms of carpal tunnel emerge - Carpal Tunnel Syndrome

Elbow, Wrist, and Hand Q and A's Gindl Flashcards by Joseph Heston

Test to check for patency of the radial and ulnar arteries

Allen’s Test

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Positive Allen’s Test

-What does it indicate?

Delay in refill of the hand

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Possible causes of a positive Allen’s

Subluxation
Reynaud’s
Old fractures
Scar tissue

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Positives for Finkelstein’s

-What do they indicate?

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

Scaphoid fracture
Stenosing Tenosynovitis of DeQuervain
Carpal subluxation

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Treatment if someone has a positive Finkelsteins

Ice and biomechanical correction

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What tendons make up the tunnel of DeQuervain?

Extensor pollicis brevis
Abductor pollicis longus

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What are some causes of ulnar nerve palsy?

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

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Positive Froment’s Test

-Indications?

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

-What ways can verify Froment’s?

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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English Test

Positive _____
Indication ______

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

Symptoms of carpal tunnel emerge
Carpal Tunnel Syndrome

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Two reasons why English Test works

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

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Orthopedic Tests for Carpal Tunnel Syndrome

English
Phalen’s
Tinel Tap

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DDx for Carpal Tunnel Syndrome

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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Carpal Tunnel Syndrome signs/symptoms

Pain
Paresthesia
Numbness
Tingling

(Median Nerve distribution)

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What is the length of time for performing English Test?

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

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

Phalen’s
English

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

Anterior lunate

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

Hyper mobile

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What makes up the carpal tunnel?

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

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What are the contents of the carpal tunnel?

Nine flexor tendons

Median Nerve

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The adjusting move of choice for someone with carpal tunnel syndrome

Wrist traction

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

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Best carpal tunnel post check

Repeat orthopedics that were positive on the precheck

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

Reverse Phalen’s

-Pushes the lunate anterior

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What would you do after treating carpal tunnel syndrome?

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

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

- Palpate for point tenderness - Palpate to differentiate whether the pain is over the raidal head or lateral epicondyle

What treatment protocol would you perform for a lateral epicondylitis?

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

Positives for Cozen's, Mill's, Lift Test in Pronation -What does this indicate?

Positive = pain over the lateral epicondyle -Indicates lateral epicondylitis

Positive finding for lift test in Supination -What does it indicate?

Pain over the medial epicondyle -Medial epicondylitis

What else could give a positive Lift test besides epicondylitis?

Lift test with pronation = Radius Posterior Lift test with supination = Ulna Posterior or Ulna Posterior Medial

Positive Adson's - What does it indicate? - How long do you palpate the radial artery?

Decrease in radial pulse amplitude (or abscence of radial pulse) - Scanlenus Anticus Syndrome (pressure on subclavian artery and brachial plexus) - 10 to 20 seconds

Positive Eden's -What does it indicate?

Decrease in radial pulse amplitude (or abscence) -Costoclavicular syndrome (TOS)

Positive Wright's -What does it indicate?

Decrease in radial pulse amplitude (or absence of radial pulse) -Hyperabduction Syndrome (TOS)

Which 3 subluxations would elbow traction work well for?

- Ulna P - Ulna PM - Radius P

What subluxation would elbow traction be the most effective for?

Ulna P

How would you post check elbow traction?

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

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

Supinate = Ulna P and PM Pronate = Radius P

What is the CP for Radius P

Tip of the thumb

What ROMs are utilized during the Radius P procedure?

Full extension and full pronation

What is the pain point for Radius P?

Right over the head of radius

What is the DDx for Radius P?

- Lateral Epicondylitis - Cervical Subluxation (C5-C6)

What ROM is decreased with Radius P?

Pronation

What subluxation might mimic the symptoms of lateral epicondylitis?

Radius P

What is the pain point for Ulna P?

1-1.5" distal to the medial epicondyle

What ROMs are utilized during the Ulna PM procedure?

Extension and supination

What is the pain point for Ulna PM?

Olecranon fossa

What is the major LOD for Ulna PM?

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

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

Posterior

What is the best post check for wrist traction?

Fluid motion between the carpals that were adjusted

Where is the pain point for wrist traction?

Right over the carpal that is misaligned

What are your stabilization hand fingers stabilizing during capitate STH?

The proximal row of carpals

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

Extension and Radial deviation

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

Trapezium, Trapazoid, and Lunate

DDx for Trapezium-Scaphoid subluxation

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

How would you differentiate the conditions in the previous DDx?

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

What is the difference between DJD and arthritis?

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

What should be ruled out before adjusting a scaphoid?

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

Name the wrist procedure from least invasive to most invasive

- Wrist traction - STH DTH

T/F The lunate usually misaligns anterior

FALSE - It usually misaligns POSTERIOR - In someone with carpal tunnel syndrome, it usually misaligns ANTERIOR

What carpal bone is the MC subluxated? - 2nd MC? - 3rd MC?

MC = Lunate 2nd MC = Capitate 3rd MC = Scaphoid

T/F Lunate posterior will be hypomobile usually

True Lunate anterior = Hypermobile (Carpal Tunnel)

Describe the wrist traction procedure for carpal tunnel syndrome?

Traction S-I Flex Return to neutral (no thrust and no extension)

Describe the wrist traction maneuver for subluxation of a carpal

Traction S-I Flex Extend Return to neutral Release

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

Wrist Traction (transverse/horizontal) -Then STH, then DTH

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

That all fingers are stabilizing the carpals around the scaphoid

What stabilizes the radius during Scaphoid DTH?

Patients' own body weight

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

Traction S-I Flex Return to Neutral (DO NOT EXTEND)

Where is the pain point for C-MC joints?

Right over the joint

What direction does the 2nd C-MC subluxated?

Rotationally

How can a 1st metacarpal subluxation be identified?

Loss of fluid motion (P-A) Point tenderness at C-MC joint Case history of a jammed thumb

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

Rotation

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

Scaphoid subluxation Scaphoid fracture Trapezium fracture Stenosing Tenosynovitis of DeQuervain Median Nerve disturbance

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

Fluid motion

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

5th C-MC

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

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.

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

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

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

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

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

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