Elbow, Wrist, Hand OSCE Flashcards
Elbow Somatic Dysfunctions
posterior radial head, anterior radial head, ulnar adduction, ulnar abduction
● Posterior Radial Head SD
ease of motion with posterior glide and pronation
● Anterior Radial Head SD
ease of motion with anterior glide and supination
● Ulnar Adduction SD
ease of motion with adduction, restriction to abduction
● Ulnar Abduction SD
ease of motion with abduction, restriction to adduction
Elbow Extensions SD TX
Patient: seated Physician: seated or standing 1. Physician places the elbow into flexion barrier 2. Patient gently attempts to extend elbow for 3-5 seconds while the physician applies an isometric counterforce. 3. Patient is instructed to completely relax. 4. Repeat steps 1-3 3-5 times or until somatic dysfunction is alleviated.
Elbow Flexion SD TX
Patient: seated, standing or supine, shoulder flexed to 90º, elbow extended Physician: seated or standing 1. Physician places the elbow into extension barrier. 2. Patient gently attempts to flex elbow for 3-5 seconds while the physician applies an unyielding counterforce. 3. Patient is instructed to completely relax. 4. Steps 1-3 are repeated 3-5 times or until somatic dysfunction is alleviated.
Elbow ADduction SD TX
Patient: seated, standing or supine, shoulder flexed to 90º, elbow extended Physician: seated or standing 1. Physician places the elbow into extension barrier. 2. Patient gently attempts to flex elbow for 3-5 seconds while the physician applies an unyielding counterforce. 3. Patient is instructed to completely relax. 4. Steps 1-3 are repeated 3-5 times or until somatic dysfunction is alleviated.
Elbow ABduction SD TX
Patient: seated, standing or supine, elbow flexed to 30° Physician: seated or standing 1. Physician places the elbow into adduction barrier. 2. Patient gently attempts to abduct the elbow for 3- 5 seconds while the physician applies an unyielding counterforce. 3. Patient is instructed to completely relax. 4. Steps 1-3 are repeated 3-5 times or until somatic dysfunction is alleviated.
Anterior Radial Head SD TX
(White Arrow – Doctor motion Black Arrow – Patient motion) 1. The patient is seated, and the physician stands facing the patient. 2. The physician grasps the patient’s hand on the side of dysfunction, contacting the dorsal aspect of the distal radius with the thumb. 3. The physician’s other hand is palm up with the thumb resting against the anterior and medial aspect of the radial head. 4. The physician pronates the patient’s forearm to the edge of the restrictive barrier. The physician instructs the patient to attempt supination while the physician applies an unyielding counterforce. 5. This isometric contraction is held for 3 to 5 seconds, and then the patient is instructed to stop and relax. 6. Once the patient has completely relaxed, the physician pronates the patient’s forearm to the edge of the new restrictive barrier while exaggerating the posterior rotation of the radial head with the left hand. 7. Steps 5 to 7 are repeated three to five times or until there is no further improvement in the restrictive barrier. 8. Range of motion of the radial head is reevaluated to determine the effectiveness of the technique.
Posterior Radial Head SD TX
(White Arrow – Doctor motion Black Arrow – Patient motion) 1. The patient is seated, and the physician stands in front of and to the side of the patient’s dysfunctional arm. 2. The physician grasps the patient’s hand on the side of dysfunction (handshake position), contacting the palmar aspect of the distal radius with the index finger. 3. The physician’s other hand is palm up with the thumb resting against the posterolateral aspect of the radial head. 4. The physician supinates the patient’s forearm until the edge of the restriction barrier is reached at the radial head. 5. The physician instructs the patient to attempt pronation while the physician applies an unyielding counterforce. 6. This isometric contraction is held for 3 to 5 seconds, and then the patient is instructed to stop and relax. Once the patient has completely relaxed, the physician supinates the patient’s forearm to the new 11 restrictive barrier while exaggerating the anterior rotation of the radial head with the other hand. 7. Steps 5 to 6 are repeated three to five times or until there is no further improvement in the restrictive barrier. 8. Range of motion of the radius is reevaluated to determine the effectiveness of the technique
Radiocarpal Flexion SD TX
(White Arrow – Doctor motion Black Arrow – Patient motion) 1.The patient is seated with the physician standing facing the patient. 2.The physician extends the patient’s wrist to the edge of the restrictive barrier. 3.The physician instructs the patient to flex the wrist while the physician applies an unyielding counterforce. 4.This isometric contraction is maintained for 3 to 5 seconds, and then the patient is instructed to stop and relax. 5.Once the patient has completely relaxed, the physician extends the patient’s wrist to the edge of the new restrictive barrier. 6.Steps 3 to 5 are repeated three to five times or until motion is maximally improved at the dysfunctional wrist. 7.Range of motion of the wrist is reevaluated to determine the effectiveness of the technique
Radiocarpal Extension SD TX
(White Arrow – Doctor motion Black Arrow – Patient motion) 1.The patient is seated with the physician standing facing the patient. 2. The physician flexes the patient’s wrist to the edge of the restrictive barrier. 3. The physician instructs the patient to extend the wrist (black arrow) while the physician applies an unyielding counterforce. 4. This isometric contraction is maintained for 3 to 5 seconds, and then the patient is instructed to stop and relax. 5. Once the patient has completely relaxed, the physician flexes the patient’s wrist to the edge of the new restrictive barrier. 12 6. Steps 3 to 5 are repeated three to five times or until motion is maximally improved at the dysfunctional wrist. 7. Range of motion of the wrist is reevaluated to determine the effectiveness of the technique.
Radiocarpal Adduction SD TX
(White Arrow – Doctor motion Black Arrow – Patient motion) 1.The patient is seated with the physician standing facing the patient. 2.The physician abducts the patient’s wrist (radial deviation) to the edge of the restrictive barrier. 3.The physician instructs the patient to adduct the wrist while the physician applies an unyielding counterforce. 4. This isometric contraction is maintained for 3 to 5 seconds, and then the patient is instructed to stop and relax. 5. Once the patient has completely relaxed, the physician abducts (radially deviates) the patient’s wrist to the edge of the new restrictive barrier. 6.Steps 3 to 5 are repeated three to five times or until motion is maximally improved at the dysfunctional wrist. 7. Range of motion of the wrist is reevaluated to determine the effectiveness of the technique.
Radiocarpal ABduction SD TX
(White Arrow – Doctor motion Black Arrow – Patient motion) 1.The patient is seated with the physician standing facing the patient 2.The physician adducts the patient’s wrist (ulnar deviation) to the edge of the restrictive. 3.The physician instructs the patient to abduct the wrist while the physician applies an unyielding counterforce. 4.This isometric contraction is maintained for 3 to 5 seconds, and then the patient is instructed to stop and relax. 5.Once the patient has completely relaxed, the physician adducts (ulnar deviation) the patient’s wrist to the edge of the new restrictive barrier. 6.Steps 3 to 5 are repeated three to five times or until motion is maximally improved at the dysfunctional wrist. 7. Range of motion of the wrist is reevaluated to determine the effectiveness of the technique.
Flexor Retinacula MFR TX
1.The patient sits on the table with the physician standing facing the patient. 2.The operator interlaces the fingers of both hands applying a thenar eminence contact across the distal radius and ulnar on the dorsal side and the wrist retinaculum on the volar side. 3.The operator maintains anteroposterior compression over the wrist while the patient actively flexes and extends fingers. 4.The patient repeats flexion and extension efforts several times, mobilizing flexor tendons under the flexor retinaculum while the operator’s hands maintain compression resulting in distraction. 5. Reassess for effectiveness of the technique.
Wrist Isotonic MET TX
Patient: Seated, standing or supine Physician: Seated or Standing 1. Physician crosses thumbs and contacts the tissue over the patient’s pisiform and trapezium 2. While the patient tries to flex the wrist, the doctor applies pressure with both thumbs in a lateral direction. 3. Physician lightens force slowly to allow patient to overcome the physician’s force. 4. Repeat steps 2-3 until somatic dysfunction is alleviated.
Figure 8 Wrist Articulation TX
Patient: Seated Physician: Seated or Standing 1. Place the patient’s wrist between the wrists of the operator (perpendicularly) 2. Move the wrist in a figure 8 motion repetitively until somatic dysfunction is alleviated.
Metacarpophalangeal Joint SD ART TX
Patient: seated, standing or supine Physician: seated or standing 1. Physician evaluates the motion at the metacarpophalangeal joint in flexion, extension, abduction, adduction, clockwise and counterclockwise circumduction. 2. When a restriction is felt, gentle repetitive motion is made through the restrictive barrier toward the anatomic barrier. 3. Continue articulation until somatic dysfunction is alleviated.
Proximal and Distal Interphalangeal Joint SD ART TX
Patient: seated, standing or supine Physician: seated or standing 1. Physician evaluates the motion at the proximal and distal interphalangeal joints in flexion, extension, abduction, adduction, clockwise and counterclockwise circumduction. 2. When a restriction is felt, gentle repetitive motion is made through the restrictive barrier toward the anatomic barrier. 3. Continue articulation until somatic dysfunction is alleviated.
