Exam I Study Guide Flashcards
Examination principles flow of procedure
History
Observation
Screens (cardiovascular, neurological, functional)
Palpation
AROM
PROM
Resisted movements
Accessory Movements (joint mobility)
Special tests
AROM and PROM painful and limited in the same direction
Inert tissue (noncontractile)
AROM and PROM painful and limited in opposite directions AND resisted motion painful in 3 positions
contractile tissue
AROM limited, PROM improved significantly or WNL and painless
motor control
Nodule protruding from wrist or dorsal hand
ganglion cyst
Palmar nodules with or without evidence of collagenous cords in the palmar fascia upon finger extension
dupuytren disease
Nodule just proximal to A1 pulley
trigger finger
Ape or claw hand
median or ulnar nerve lesion, respectively
Thenar atrophy
CTS or median nerve lesion
Hypothenar atrophy
ulnar nerve lesion
Wrist drop
radial nerve lesion
Drooping of the distal phalanx
mallet finger
Loss of DIP joint flexion
FDP tendon avulsion or laceration
Bouchard (PIP joint) or Heberden (DIP joint) nodes
Osteoarthritis
Boutonniere deformity /Swan-neck deformity
Rheumatoid arthritis
Bunnell- Littler Test/ Intrinsic Plus Test
Used to determine cause of PIP flexion restriction,
Tinel sign
Tap proximal carpal ligament 4-6 times, positive if pt reports pain over median nerve distribution or paresthesia. Not a good test
Phalen’s test
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
reverse phalen’s test
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
Carpal compression test
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
Carpal tunnel syndrome test cluster
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
Scaphoid fracture tests
anatomical snuff box tenderness, pain with longitudinal compression of the thumb, pain with supination against resistance
pain with supination against resistance test
Hold patient hand in handshake position and resist supination, positive if it is painful
Scaphoid fracture CPR
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
first carpometacarpal grind test
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
lever test
Therapist passively moves first Carpometacarpal joint radially and ulnarly to endpoint (endfeel). positive is pain reproduction
Metacarpophalangeal Extension test
Isometric resistance of first Carpometacarpal into extension (pressure at Interphalangeal joint), positive is pain reproduction. Good test for ruling in, bad for ruling out
Finkelstein Test/ Eichhoff Test- tenosynovitis (abductor pollicis longus and extensor pollicis brevis)
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
Press Test- Triangular Fibrocartilage Complextear
Patient is asked to push self up from chair with palms flat/ wrists in extension. Positive if pain along ulnar side of wrist
wrist ratio index
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
Swelling local to posterior tip of elbow
olecranon bursitis
Diminished tip of olecranon
dislocation or fracture
Altered carrying angle
non union or mal union of the humerus
nodules and synovitis on elbow
RA
Allen test
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.
Limited General Mobility of Flex/Ext. of humeraulnar joint
test distraction, improves general mobility of flexion and extension
limited extension at end range of humeraulnar joint
Test distraction at end of available extension ROM, Improve end range Extension
Limited Elbow Extension and Radial Head Mobility of radiohumeral joint
test distraction of RH joint, improve general mobility and extension
Limited Pronation on radiohumeral joint
test posterior/dorsal glide, improve forearm pronation
Limited Supination on radiohumeral joint
test anterior (ventral) glide, improve forearm supination
MCL grade 1 tear
a small number of fibers are torn resulting in pain but full function
MCL grade 2 tear
a significant number of fibers are torn with pain and moderate loss of function
MCL grade 3 tear
all fibers are ruptured with elbow instability and major loss of function
Pressure Provocation test
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
Flexion Test
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
Combined pressure and Flexion
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
MCL/ Ulnar Collateral Ligament, Valgus Stress Test
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
MVL/ Ulnar Collateral Ligament, Moving Valgus Stress Test
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
Mill’s stress test
Palpate lateral epicondyle, examiner passively pronates forearm, flexes wrist, and extends elbow.
positive if reproduction of symptoms and pain over lateral epicondyle of humerus
Cozen’s test
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
Biceps squeeze test
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
Bicipital aponeurosis flex test
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
Hook Test
Therapists uses index finger to palpate bicep tendon – Positive =NO tendon
Passive forearm pronation test
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
Bicep crease interval
distance from antecubital crease to distal muscle belly
positive if >6 cm
4 way ROM test for fracture
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
Elbow extension test for fracture
Patient seated with arms supinated
Patient actively flexes shoulders to 90 degrees
Patient extends elbow
Positive of decreased ROM in involved elbow
Closed pack positions for elbow
70 degrees of flexion, slight supination
closed pack position humeraulnar
full extension
closed pack position humeral radial
full flexion and supination
