Elbow, Wrist, Hand Diagnosis and Treatment Flashcards
Wrist Extensors attachment
lateral epicondyle
Wrist flexors attachment
medial epicondyle
ulnar nerve is between what two structures?
medial epicondyle and olecranon
> 15 degrees v.
Cubitus vaglus v. Cubit varus
ABduction is the accessory rocking motion of the proximal ulna with ____ of the forearm
Pronation
ADduction is the accessory rocking motion of the proximal ulna with ____ of the
forearm
Supination
Radial head:
Glides anteriorly with ___ of the forearm
Glides posteriorly with ___ of the forearm
Glides anteriorly with supination of the forearm.
Glides posteriorly with pronation of the forearm.
Describe ME for Posterior Radial Head, Pronation
(Abduction) Dysfunctions
Doctor takes flexed elbow into full supination (into restrictive barrier) – Pt applies isometric counterforce (attempts pronation).
Describe ME for Anterior Radial Head, Supination (Adduction) Dysfunctions
Doctor takes flexed elbow into full pronation (into restrictive barrier) – Pt applies isometric counterforce (attempts supination).
Describe HVLA for Abduction/Adduction Ulnar
Dysfunctions (Dysfunctions of Olecranon)
what force is abd v. add?
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).
Describe HVLA for anterior radial head dysfunction
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.
Describe HVLA for Posterior Radial Head Dysfunction – more common
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.
Name the three MFR techniques
radioulnar release (bonus technique), wrist-forearm-elbow transverse approach, interosseous release
Describe ME for radial deviation dysfunction
Doc takes into ulnar deviation. Pt radially deviates against resistance.
20-30° abduction expected as normal.
Describe ME for ulnar deviation dysfunction
Doc takes into Radial deviation. Pt ulnar deviates against resistance.
30-40° adduction expected as normal.
Describe ME for Estension wrist/carpal dysfunction
Doc takes wrist into flexion restrictive barrier. Pt extends against equal resistance.
70° extension expected as normal.
Describe Me for Flexion wrist/carpal dysfunction
Doc takes wrist into extension restrictive barrier. Pt flexes against equal resistance.
80-90° flexion expected as normal.
Describe HVLA for wrist flexion (dorsal carpal glide) dysfunction
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
Describe HVLA for wrist extension (ventral carpal glide) dysfunction
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
Describe HVLA for ulnar deviation wrist/carpal dysfunction OR radial deviation wrist/carpal dysfunction
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
Describe HVLA for phalangeal dysfuntion
Assess ROM of flexion/extension, abd/add,
int/ext rotation.
Isolate dysfunctional joint. While exerting traction, simultaneously deliver a corrective hyperflexion thrust.
Describe MFR for Wrist Flexor Retinaculum Dysfunction
(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.
What dysfunctions can be treated with Articulatory for Wrist/Carpal
dysfunctions?
Flexion & extension
with glide and abd/add
dysfunctions
What articulatory techniques can be used for the hand?
Phalangeal dysfunction
-take phalanx through its range of motion (clockwise & counter-clockwise) while applying traction.
