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Patient Management II > Exam I Study Guide > Flashcards

Exam I Study Guide Flashcards

1
Q

Examination principles flow of procedure

A

History
Observation
Screens (cardiovascular, neurological, functional)
Palpation
AROM
PROM
Resisted movements
Accessory Movements (joint mobility)
Special tests

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2
Q

AROM and PROM painful and limited in the same direction

A

Inert tissue (noncontractile)

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3
Q

AROM and PROM painful and limited in opposite directions AND resisted motion painful in 3 positions

A

contractile tissue

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4
Q

AROM limited, PROM improved significantly or WNL and painless

A

motor control

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5
Q

Nodule protruding from wrist or dorsal hand

A

ganglion cyst

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6
Q

Palmar nodules with or without evidence of collagenous cords in the palmar fascia upon finger extension

A

dupuytren disease

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7
Q

Nodule just proximal to A1 pulley

A

trigger finger

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8
Q

Ape or claw hand

A

median or ulnar nerve lesion, respectively

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9
Q

Thenar atrophy

A

CTS or median nerve lesion

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10
Q

Hypothenar atrophy

A

ulnar nerve lesion

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11
Q

Wrist drop

A

radial nerve lesion

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12
Q

Drooping of the distal phalanx

A

mallet finger

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13
Q

Loss of DIP joint flexion

A

FDP tendon avulsion or laceration

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14
Q

Bouchard (PIP joint) or Heberden (DIP joint) nodes

A

Osteoarthritis

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15
Q

Boutonniere deformity /Swan-neck deformity

A

Rheumatoid arthritis

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16
Q

Bunnell- Littler Test/ Intrinsic Plus Test

A

Used to determine cause of PIP flexion restriction,

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17
Q

Tinel sign

A

Tap proximal carpal ligament 4-6 times, positive if pt reports pain over median nerve distribution or paresthesia. Not a good test

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18
Q

Phalen’s test

A

Patient instructed to flex both wrists to 90 degrees with dorsal aspects held in opposition and hold for 60 seconds. Positive if paresthesias in at least one digit innervated by median nerve. Not a good test

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19
Q

reverse phalen’s test

A

Patient instructed to extend both wrists to with palmar aspects held in opposition and hold 60 seconds. Positive if paresthesias in at least one digit innervated by median nerve. Not a good test

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20
Q

Carpal compression test

A

Examiner provides compression over median nerve at carpal tunnel with 2 fingers for30 seconds. Positive if pain or paresthesias, or numbness is produced. Good test for ruling out but not ruling in

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21
Q

Carpal tunnel syndrome test cluster

A

Clinical Prediction Rule (4 out of 5 symptoms= +LR 18.3)

Brigham and Women’s Hospital Hand Severity Scale score >1.9
Wrist ratio index > .67
Report of shaking hand provides symptom relief
Diminished sensation on thumb pad
Age > 45

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22
Q

Scaphoid fracture tests

A

anatomical snuff box tenderness, pain with longitudinal compression of the thumb, pain with supination against resistance

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23
Q

pain with supination against resistance test

A

Hold patient hand in handshake position and resist supination, positive if it is painful

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24
Q

Scaphoid fracture CPR

A

4 predictors of fracture (all 4 +=91% risk of fracture)

Male gender
Sports injury
Anatomic snuffbox pain on ulnar deviation of wrist within 72 hours of injury
Scaphoid tubercle tenderness at 2 weeks

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25
Q

first carpometacarpal grind test

A

Compress the first metacarpal into the trapezium using an axial load and rotate the metacarpal; result is positive if it reproduces the patent’s pain, good test for ruling in, bad for ruling out

26
Q

lever test

A

Therapist passively moves first Carpometacarpal joint radially and ulnarly to endpoint (endfeel). positive is pain reproduction

27
Q

Metacarpophalangeal Extension test

A

Isometric resistance of first Carpometacarpal into extension (pressure at Interphalangeal joint), positive is pain reproduction. Good test for ruling in, bad for ruling out

28
Q

Finkelstein Test/ Eichhoff Test- tenosynovitis (abductor pollicis longus and extensor pollicis brevis)

A

Patient places thumb into flexion and fingers are flexed along thumb, Patient then ulnarly deviates wrist, Overpressure is provided by examiner over index finger. Positive if pain and limited ROM

29
Q

Press Test- Triangular Fibrocartilage Complextear

A

Patient is asked to push self up from chair with palms flat/ wrists in extension. Positive if pain along ulnar side of wrist

30
Q

wrist ratio index

A

Measured by using a pair of sliding calipers to measure the anteroposterior (AP) wrist width and the mediolateral (ML) wrist width at the distal wrist crease.

Wrist ratio index is then calculated by dividing the anteroposterior wrist width by the mediolateralwrist width in centimeters.

Positive if >.67

31
Q

Swelling local to posterior tip of elbow

A

olecranon bursitis

32
Q

Diminished tip of olecranon

A

dislocation or fracture

33
Q

Altered carrying angle

A

non union or mal union of the humerus

34
Q

nodules and synovitis on elbow

A

RA

35
Q

Allen test

A

Patency of the radial and ulnar arteries

Compress both arteries and have the patient make a fist 3-5 times

Open fist and palm should be pale

Release compression on one artery and note time to flush to normal color

Repeat with other artery and note a difference between sides.

36
Q

Limited General Mobility of Flex/Ext. of humeraulnar joint

A

test distraction, improves general mobility of flexion and extension

37
Q

limited extension at end range of humeraulnar joint

A

Test distraction at end of available extension ROM, Improve end range Extension

38
Q

Limited Elbow Extension and Radial Head Mobility of radiohumeral joint

A

test distraction of RH joint, improve general mobility and extension

39
Q

Limited Pronation on radiohumeral joint

A

test posterior/dorsal glide, improve forearm pronation

40
Q

Limited Supination on radiohumeral joint

A

test anterior (ventral) glide, improve forearm supination

41
Q

MCL grade 1 tear

A

a small number of fibers are torn resulting in pain but full function

42
Q

MCL grade 2 tear

A

a significant number of fibers are torn with pain and moderate loss of function

43
Q

MCL grade 3 tear

A

all fibers are ruptured with elbow instability and major loss of function

44
Q

Pressure Provocation test

A

cubital tunnel, patients elbow in 20 degrees of flexion, pressure applied just proximal to cubital tunnel, hold 60 seconds

Positive if symptoms along ulnar nerve distribution

great test

45
Q

Flexion Test

A

Cubital tunnel, Place patients elbow in full flexion with supination of the forearm, wrist in neutral, Hold position 60 sec

Positive if symptoms along ulnar nerve distribution

great test

46
Q

Combined pressure and Flexion

A

Cubital tunnel, Place patients elbow in full flexion with supination of the forearm, wrist in neutral, Pressure applied just proximal to cubital tunnel, Hold position 60 sec

Positive if symptoms along ulnar nerve distribution

great test

47
Q

MCL/ Ulnar Collateral Ligament, Valgus Stress Test

A

Elbow placed in 20 degrees flexion, Examiner palpates medial joint line and applies valgus force to the elbow

positive if Patient reports pain or excessive laxity compared to opposite UE

not a good test

48
Q

MVL/ Ulnar Collateral Ligament, Moving Valgus Stress Test

A

Patients shoulder is abducted to 90 degrees and elbow is placed in full flexion

Examiner holds forearm in one hand and stabilizes elbow with other hand

Examiner applies a valgus force and simultaneously ER the shoulder.

Examainer then quickly extends elbow to 30 degrees

positive if Pain at medial elbow AND maximum amount of pain between 120-70 degrees of elbow flexion

not a good test

49
Q

Mill’s stress test

A

Palpate lateral epicondyle, examiner passively pronates forearm, flexes wrist, and extends elbow.

positive if reproduction of symptoms and pain over lateral epicondyle of humerus

50
Q

Cozen’s test

A

Examiner’s thumb at lateral epicondyle.

Patient’s elbow flexed and pronated, with wrist extended/RD.

Therapist resists Wrist Extension/RD.

positive if reproduction of symptoms and sudden severe pain of lateral epicondyle of humerus

51
Q

Biceps squeeze test

A

Patient seated with elbow flexed 60-80 degrees and forearm in slight pronation (resting in lap).

Therapist squeezes biceps firmly with both hands (One hand along muscle belly, One hand at distal myotendinous junction)

positive if lack of forearm supination when bicep is squeezed

52
Q

Bicipital aponeurosis flex test

A

Patients arm is supinated and elbow extended

Patient is asked to make a fist and ACTIVELY flex wrist

While maintaining wrist position, patient is asked to ACTIVELY flex elbow to 75 degrees

Therapist palates medial antecubital fossa for thin edge of aponeurosis

53
Q

Hook Test

A

Therapists uses index finger to palpate bicep tendon – Positive =NO tendon

54
Q

Passive forearm pronation test

A

Therapist PASSIVELY moves patient forearm from a supinated position into pronation

Loss of visual and palpable proximal to distal movement of the bicep mus belly

55
Q

Bicep crease interval

A

distance from antecubital crease to distal muscle belly

positive if >6 cm

56
Q

4 way ROM test for fracture

A

Patient seated with injured arm at patient side with elbow extended.
Patient asked to ACTIVELY
1) extend to a full locked position
2) flex elbow to 90 degrees
3) while flexed pronate to full ROM
4) while flexed supinate to full ROM

Positive if decreased ROM in any of 4 maneuvers

not a good test

57
Q

Elbow extension test for fracture

A

Patient seated with arms supinated

Patient actively flexes shoulders to 90 degrees

Patient extends elbow

Positive of decreased ROM in involved elbow

58
Q

Closed pack positions for elbow

A

70 degrees of flexion, slight supination

59
Q

closed pack position humeraulnar

A

full extension

60
Q

closed pack position humeral radial

A

full flexion and supination

Patient Management II (8 decks)

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