Elbow, Wrist, Hand Diagnosis and Treatment

Question 1

Wrist Extensors attachment

Answer 1

lateral epicondyle

Question 2

Wrist flexors attachment

Answer 2

medial epicondyle

Question 3

ulnar nerve is between what two structures?

Answer 3

medial epicondyle and olecranon

Question 4

> 15 degrees v.

Answer 4

Cubitus vaglus v. Cubit varus

Question 5

ABduction is the accessory rocking motion of the proximal ulna with ____ of the forearm

Answer 5

Pronation

Question 6

ADduction is the accessory rocking motion of the proximal ulna with ____ of the
forearm

Answer 6

Supination

Question 7

Radial head:
 Glides anteriorly with ___ of the forearm
 Glides posteriorly with ___ of the forearm

Answer 7

Glides anteriorly with supination of the forearm.

Glides posteriorly with pronation of the forearm.

Question 8

Describe ME for Posterior Radial Head, Pronation

(Abduction) Dysfunctions

Answer 8

Doctor takes flexed elbow into full supination (into restrictive barrier) – Pt applies isometric counterforce (attempts pronation).

Question 9

Describe ME for Anterior Radial Head, Supination (Adduction) Dysfunctions

Answer 9

Doctor takes flexed elbow into full pronation (into restrictive barrier) – Pt applies isometric counterforce (attempts supination).

Question 10

Describe HVLA for Abduction/Adduction Ulnar
Dysfunctions (Dysfunctions of Olecranon)

what force is abd v. add?

Answer 10

Supinate and fully extend elbow. Grasp elbow with fingers of monitoring hand on
either side of olecranon; other hand grasps distal radius/ulnar. Assess dysfunctional barriers and apply a corrective thrust into
barrier either adduction (varus force) or abduction (valgus force).

Question 11

Describe HVLA for anterior radial head dysfunction

Answer 11

Place 2nd and 3rd fingers of one hand into the crease of the patients elbow contacting
directly over the radial head. Other hand flexes elbow and pronates forearm. Take the
elbow into hyperflexion while
simultaneously thrusting the radial head dorsally.

Question 12

Describe HVLA for Posterior Radial Head Dysfunction – more common

Answer 12

Engage restrictive barrier with one hand’s thumb over posterior radial head; other hand grasping pt’s distal radius/ulna bringing elbow into extension & supination. HVLA
thrust is a simultaneous ventral force on radial head and elbow hyperextension.

Question 13

Name the three MFR techniques

Answer 13

radioulnar release (bonus technique), wrist-forearm-elbow transverse approach, interosseous release

Question 14

Describe ME for radial deviation dysfunction

Answer 14

Doc takes into ulnar deviation. Pt radially deviates against resistance.
20-30° abduction expected as normal.

Question 15

Describe ME for ulnar deviation dysfunction

Answer 15

Doc takes into Radial deviation. Pt ulnar deviates against resistance.
30-40° adduction expected as normal.

Question 16

Describe ME for Estension wrist/carpal dysfunction

Answer 16

Doc takes wrist into flexion restrictive barrier. Pt extends against equal resistance.
70° extension expected as normal.

Question 17

Describe Me for Flexion wrist/carpal dysfunction

Answer 17

Doc takes wrist into extension restrictive barrier. Pt flexes against equal resistance.
80-90° flexion expected as normal.

Question 18

Describe HVLA for wrist flexion (dorsal carpal glide) dysfunction

Answer 18

Grasp patient’s hand, thumbs contacting dorsally at the proximal carpal bones (radiocarpal joint).
Flexion Dysfunction: Doctor delivers a whip-like thrust moving from flexion to a
countering extension and ventral glide force through the carpal dysfunction. REASSESS

Question 19

Describe HVLA for wrist extension (ventral carpal glide) dysfunction

Answer 19

Grasp patient’s hand, thumbs contacting dorsally at the proximal carpal bones (radiocarpal joint).
Extension Dysfunction: Doctor delivers a whip-like thrust moving from extension to a
countering flexion and dorsal glide force through the carpal dysfunction. REASSESS

Question 20

Describe HVLA for ulnar deviation wrist/carpal dysfunction OR radial deviation wrist/carpal dysfunction

Answer 20

30-40° adduction expected as normal.
20-30° abduction expected as normal.
Pt seated, elbow flexed 90°; doc facing patient to side of dysfunction. Contact hand
with one hand and pt’s distal radius/ulna with the other. Engage restrictive barrier then
provide HVLA thrust. REASSESS

Question 21

Describe HVLA for phalangeal dysfuntion

Answer 21

Assess ROM of flexion/extension, abd/add,
int/ext rotation.
Isolate dysfunctional joint. While exerting traction, simultaneously deliver a corrective hyperflexion thrust.

Question 22

Describe MFR for Wrist Flexor Retinaculum Dysfunction

Answer 22

(Carpal Tunnel release)
Dx: Palpate for tissue texture changes and tenderness deep in wrist between thenar and hypothenar eminence.
Tx: Pt seated, Dr standing in facing pt. Pt’s hand placed palm up with wrist in extension. Dr’s thumbs placed over anterior aspect, one on each end of
retinaculum; fingers wrap around dorsal aspect. Provide force with thumbs pressing posteriorly and apart. Maintain for tissue
creep (~60 sec). Stop if severe
pain/paresthesias in median nerve distribution occur otherwise repeat until release of tension.

Question 23

What dysfunctions can be treated with Articulatory for Wrist/Carpal
dysfunctions?

Answer 23

Flexion & extension
with glide and abd/add
dysfunctions

Question 24

What articulatory techniques can be used for the hand?

Answer 24

Phalangeal dysfunction

-take phalanx through its range of motion (clockwise & counter-clockwise) while applying traction.