Examination - Elbow, Wrist, and Hand Flashcards
1
Q
Examination - History:
- Three goals = ?
- Three guideline = ?
Examination - E,W,H
A
(a) Goals:
- Form a subjective Hypothesis
- Thorough, yet Concise
- Build Patient Rapport
(b) Guidelines:
- Be confident
- Be Compassionate
- Use Active Listening (Pace… pace… lead)
- Watch for non-verbal cues
2
Q
Review of Systems & Red Flags:
- General Health = ?
- Cardiopulmonary = ?
- Integumentary = ?
- Metabolic = ?
- Lifestyle = ?
- Medications (Types) = ?
- Red Flags = ?
Examination - E,W,H
A
(a) General Health:
- Malaise
- Night Pain
- Dizziness
- Chills/Sweats/Fever
- Unexplained Weight Loss
(b) Cardiopulmonary:
- Auscultation & Vital Signs*
- Lightheadedness
- Cramping
- Coughing
(c) Integumentary:
- Skin or Trophic Changes*
(d) Metabolic:
- Diabetes
- Metabolic Syndrome
- Lifestyle:
- Sleep, Diet, Activity
- Smoking
(e) Medications (Types):
- Anti-inflammatory
- Nerve/Muscle
- Cholesterol
- Psych
Red Flags:
- Prior History of Cancer
- Unexplained Fever
3
Q
SINSS = ?
Examination - E,W,H
A
SINSS:
(a) Severity
- Mild
- Moderate
- Severe
(b) Irritability
- Mild
- Moderate
- Severe
(c) Nature
- Nociceptive
- Inflammatory
- Neuropathic
- Autonomic
- Psychosocial
(d) Stage
- Acute
- Recurrent
- Chronic
(e) Stability
- Improving
- Not-changing
- Worsening
4
Q
Aggravating and Easing Factors:
- Four Kennedy Stages = ?
Examination - E,W,H
A
Aggravating and Easing Factors - Kennedy Stages:
(1) Pain After
- Reduction = 0-25%
(2) Pain Before and After
- Reduction = 25-50%
(3) Pain Before, During, and After (Performance Unaffected)
- Reduction = 50-75%
(4) Pain Before, During, and After (Performance Affected)
- Reduction = 75-100%
5
Q
Pain Pattern Takeaways:
- The More Distal The Pain = ?
Examination - E,W,H
A
Pain Pattern Takeaways:
(a) The More Distal The Pain = The More Accurate The Pain Location.
(b) You can’t diagnose on pain patterns alone, but…
- Pain patterns can still be a useful tool.
6
Q
Observation:
- When should you start oberservation = ?
- Clinical pearl = ?
Examination - E,W,H
A
Observation:
(a) Start Observing in the Waiting Room.
(b) Clinical Pearl =
- Consider taking Clinical Photographs for Documentation
(c) Notes:
Frontal View:
- Guarding of the Arm
- Carrying Angle
- Skin Appearance (Sheen | Ecchymosis)
- Swelling
- Hand Atrophy
Side View
- Attitude of the Hand
- Wrist Deformities
- Swelling
- Hand Deformities
- Nail Bed Changes
7
Q
Neural Hand Deformities:
- You see this, what nerve are you thinking= ?
Examination - E,W,H
A
Neural Hand Deformities:
(a) You see this, what nerve are you thinking…
- Radial Nerve
8
Q
Neural Hand Deformities:
- You see this, what nerve are you thinking= ?
Examination - E,W,H
A
Neural Hand Deformities:
(a) You see this, what nerve are you thinking…
- Ulnar Nerve
9
Q
Neural Hand Deformities:
- You see this, what nerve are you thinking= ?
Examination - E,W,H
A
Neural Hand Deformities:
(a) You see this, what nerve are you thinking…
- Ulnar Nerve
10
Q
Neural Hand Deformities:
- You see this, what nerve are you thinking= ?
Examination - E,W,H
A
Neural Hand Deformities:
(a) You see this, what nerve are you thinking…
- Median Nerve
11
Q
Neural Hand Deformities:
- You see this, what nerve are you thinking= ?
Examination - E,W,H
A
Neural Hand Deformities:
(a) You see this, what nerve are you thinking…
- Median Nerve
12
Q
Explain how to perform the Moberg Pick-up Test = ?
Examination - E,W,H
A
Moberg Pick-up Test:
(a) Procedure:
- With eyes open, place 12 items in a box with the dominant hand.
- With eyes closed, place 12 items in a box with the dominant hand.
13
Q
Elbow Extension Test = ?
Examination - E,W,H
A
Elbow Fracture - Elbow Extension Test:
(a) Client Position:
- Supine or sitting and elbow fully extended and supported on a pillow.
(b) Clinician Position:
- Monitoring client from the side.
(c) Movement:
- The client attempts to fully extend their elbow
(d) Assessment:
- Positive Test: Inability to fully extend te elbow, with comparison to unaffected side.
Statistics:
- SN = 97 (85-100)
- SP = 69 (57-80)
- Positive (+) LR = 3.1
- Negative (-) LR = 0.04
- QUADAS = 10
14
Q
Scaphoid Compression Test = ?
Examination - E,W,H
A
Scaphoid Fracture - Scaphoid Compression Test:
(a) Client Position:
- Sitting with arms relaxed
(b) Clinician Position:
- Sitting next to the client
(c) Movement:
- The clinician provides longitudinal pressure through the thumb, producing compression on the scaphoid.
(d) Assessment:
- Positive Test: Reproduction of the client’s pain at the wrist
15
Q
Anatomical Snuffbox Tenderness Test = ?
Examination - E,W,H
A
Scaphoid Fracture - Anatomical Snuffbox Tenderness:
(a) Client Position:
- Sitting with arms relaxed
(b) Clinician Position:
- Sitting next to the client
(c) Movement:
- The clinician palpates and provides pressure on the anatomical snuffbox
(d) Assessment:
- Positive Test: Pain or tenderness during palpation with pressure
Statistics:
- SN = 90 (80-100)
- SP = 40 (33-47)
- Positive (+) LR = 2.37
- Negative (-) LR = 2.25
- QUADAS = 8
16
Q
Objective Examination:
- Three goals = ?
- Three guidelines = ?
Examination - E,W,H
A
Objective Examination:
(a) Goals:
- Confirm your subjective Hypothesis
- Determine Movement capabilities
- Quantity, Quality, Willingness
- Narrow/Prioritize Treatment Options
(b) Guidelines:
- Be confident
- Explain Procedures well
- Watch for non-verbal cues
- Don’t push into aggravating Positions too early
- Appropriately expose areas for observation
17
Q
Elbow Range of Motion - Normative Values:
- Flexion / Extension = ?
- Pronation = ?
- Supination = ?
Examination - E,W,H
A
Elbow Range of Motion:
(a) Flexion / Extension normative values
- 0-150
(b) Pronation
- 0-80
(c) Supination
- 0-80
18
Q
Wrist and Hand Range of Motion - Normative Values:
- Flexion = ?
- Extension = ?
- Ulnar Deviation = ?
- Radial Deviation = ?
Examination - E,W,H
A
Wrist and Hand Range of Motion - Normative Values:
(a) Flexion
- 0-80
(b) Extension
- 0-70
(c) Ulnar Deviation
- 0-30
(d) Radial Deviation
- 0-20
19
Q
Selective Manual Muscle Testing:
- Extensor carpi radialis longus & brevis, what nerve = ?
Examination - E,W,H
A
Selective Manual Muscle Testing:
(a) Extensor carpi radialis longus & brevis, what nerve
- Proximal Radial n.
20
Q
Selective Manual Muscle Testing:
- Extensor digitorum, what nerve = ?
Examination - E,W,H
A
21
Q
Selective Manual Muscle Testing:
- Flexor carpi radialis, what nerve = ?
Examination - E,W,H
A
22
Q
Selective Manual Muscle Testing:
- Flexor pollicis brevis, what nerve = ?
Examination - E,W,H
A
23
Q
Selective Manual Muscle Testing:
- Flexor carpi ulnaris, what nerve = ?
Examination - E,W,H
A
24
Q
Selective Manual Muscle Testing:
- Palmer interossei, what nerve = ?
Examination - E,W,H
A
25
Humeroulnar Joint Medial Glide = **?**
## Footnote
*Examination - E,W,H*
Humeroulnar Joint Play Testing - [**Humeroulnar Joint Medial Glide**](https://www.youtube.com/watch?v=VMHwmfolCwk&t=113s)
(a) **Client Position**:
(b) **Clinician Position**:
(c) **Stabilization**:
(d) **Movement and Direction of Force**:
(e) **Assessment**:
## Footnote
**Statistics**:
* SN =
* SP =
* Positive (+) LR =
* Negative (-) LR =
* QUADAS =
26
Humeroulnar Joint Play Testing:
* Humeroulnar Joint Distraction = **?**
## Footnote
*Examination - E,W,H*
Joint Play - [**Humeroulnar Joint Distraction**](https://www.youtube.com/watch?v=VMHwmfolCwk&t=49s)
(a) **Client Position**:
* Supine with arms relaxed at side, elbow on clinician's sholder with forearm partially supinated.
(b) **Clinician Position**:
* Sitting at the clients elbow, facing the client.
(c) **Stabilization**:
* The rest of the client's body on the table serves as the stabilizing force. The clinician's stabilizing hand (left as shown) purchases the proximal humerus.
(d) **Movement and Direction of Force**:
* The clinicians assessing hand (right as shown) purchases the proximal ulna, just distal to the elbow. The clinician uses their assessing hand to distract the ulna distally from the humerus at a 90 degree angle from the treatment plane, or an angle 45 degrees less flexion than the position of the ulnar shaft.
(d) **Assessment**:
* Assessment is done for joint play/passive accessory motion, client response, and end-feel. Reproduction of concordant pain suggests dysfunction.
* Impaired joint mobility or end-feel may also suggest dysfunction if concordant pain is also reproduced.
## Footnote
[USM DPT Video](https://www.youtube.com/watch?v=VMHwmfolCwk&t=49s)
**Statistics**:
* SN =
* SP =
* Positive (+) LR =
* Negative (-) LR =
* QUADAS =
27
Humeroulnar Joint Medial Glide = **?**
## Footnote
*Examination - E,W,H*
Joint Play - [**Humeroulnar Joint Medial Glide**](https://www.youtube.com/watch?v=VMHwmfolCwk&t=113s)
(a) **Client Position**:
* Supine with arm relaxed at side
(b) **Clinician Position**:
* Sitting or standing at the client's side with the client's arm braced between their side and mobilizing arm (left as shown). The clinician maintains the client's arm in a partially supinated position as they use their proximal hand (right as shown) to stabilize the medial distal humerus and their caudal hand (mobilizing hand; left as shown) to purchase the lateral aspect of the client's proximal forearm (radius).
(c) **Stabilization**:
* The rest of the client's body on the table serves as a stabilizng force. The clinicians stabilizing hand purchases the distal humerus.
(d) **Movement and Direction of Force**:
* The clinician's assessing hand purchases the proximal radius and ulna, just distal to the elbow. The clinician uses their assessing hand to glide the proximal ulna in a medial direction throught he radius (assisting with their trunk).
(d) **Assessment**:
* Assessment is done for joint play/passive accessory motion, client response, and end-feel. Reproduction of concordant pain suggests dysfunction. Impaired joint mobility or end-feel may also suggest dysfunction if concordant pain is also reported.
## Footnote
**Statistics**:
* SN =
* SP =
* Positive (+) LR =
* Negative (-) LR =
* QUADAS =
28
Humeroulnar Joint Lateral Glide = **?**
## Footnote
*Examination - E,W,H*
Humeroulnar Joint Play Testing - [**Humeroulnar Joint Lateral Glide**](https://www.youtube.com/watch?v=VMHwmfolCwk&t=113s)
(a) **Client Position**:
(b) **Clinician Position**:
(c) **Stabilization**:
(d) **Movement and Direction of Force**:
(e) **Assessment**:
29
Humeroradial Joint Distraction = **?**
## Footnote
*Examination - E,W,H*
Humeroradial Joint Play Testing - [**Humeroradial Joint Distraction**](https://www.youtube.com/watch?v=VMHwmfolCwk&t=198s):
(a) **Client Position**:
(b) **Clinician Position**:
(c) **Stabilization**:
(d) **Movement and Direction of Force**:
(e) **Assessment**:
30
Humeroradial Joint Posterior Glide = **?**
## Footnote
*Examination - E,W,H*
Humeroradial and PRUJ Joint Play - [**Humeroradial Joint Posterior Glide**](https://www.youtube.com/watch?v=VMHwmfolCwk&t=252s):
(a) **Client Position**:
(b) **Clinician Position**:
(c) **Stabilization**:
(d) **Movement and Direction of Force**:
(e) **Assessment**:
31
Humeroradial Joint Anterior Glide = **?**
## Footnote
*Examination - E,W,H*
Humeroradial and PRUJ Joint Play - [**Humeroradial Joint Anterior Glide**](https://www.youtube.com/watch?v=VMHwmfolCwk&t=252s):
(a) **Client Position**:
(b) **Clinician Position**:
(c) **Stabilization**:
(d) **Movement and Direction of Force**:
(e) **Assessment**:
32
Distal Radioulnar Joint Posterior (Dorsal) Glide of the Radius = **?**
## Footnote
*Examination - E,W,H*
DRUJ Joint Play Testing - [**Distal Radioulnar Joint Posterior (Dorsal) Glide of the Radius**](https://www.youtube.com/watch?v=VMHwmfolCwk&t=315s)
(a) **Client Position**:
(b) **Clinician Position**:
(c) **Stabilization**:
(d) **Movement and Direction of Force**:
(e) **Assessment**:
33
Distal Radioulnar Joint Anterior (Volar) Glide of the Radius = **?**
## Footnote
*Examination - E,W,H*
DRUJ Joint Play Testing - [**Distal Radioulnar Joint Anterior (Volar) Glide of the Radius**](https://www.youtube.com/watch?v=VMHwmfolCwk&t=315s)
(a) **Client Position**:
* Supine or sitting with arm resting on table; elbow flexed, 10° supination.
(b) **Clinician Position**:
* Standing at the client’s elbow.
(c) **Stabilization**:
* The rest of the client’s body on the table serves as a stabilizing force.
* The clinician’s stabilizing hand (right as shown) purchases the distal ulna on the anterior or volar side.
(d) **Movement and Direction of Force**:
* The clinician uses their assessing hand (left as shown) to purchase the distal radius, with the heel of their hand purchasing the radial head on the posterior or dorsal side.
* The clinician uses their assessing hand to glide the distal radius in an **anterior** or volar direction.
(e) **Assessment**:
34
Wrist (Radiocarpal and Ulnocarpal) Posterior (Dorsal) Glide = **?**
## Footnote
*Examination - E,W,H*
Wrist Posterior Joint Play Testing - [**Wrist (Radiocarpal and Ulnocarpal) Posterior (Dorsal) Glide**](https://app.clinicalpattern.com/ortho/p1769/)
(a) **Client Position**:
* Sitting with the wrist in neutral, with the forearm supported on the table and the thumb facing the ceiling.
(b) **Clinician Position**:
* Standing or sitting (as shown) at the client’s side to be assessed.
(c) **Stabilization**:
* The rest of the client’s body on the table serves as a stabilizing force.
* The clinician’s stabilizing hand (right as shown) purchases the distal radius and ulna against the table.
(d) **Movement and Direction of Force**:
* The clinician’s assessing hand (left as shown) purchases the proximal row of carpal bones.
* The clinician’s assessing hand glides the proximal row of carpal bones in a posterior (dorsal) direction (away from clinician).
(e) **Assessment**:
* Assessment is done for joint play/passive accessory motion, client response, and end-feel.
* Reproduction of concordant pain suggests potential dysfunction. Impaired joint mobility or end-feel may also suggest dysfunction if concordant pain is also reproduced.
35
Wrist Anterior (Volar/Palmar) Glide = **?**
## Footnote
*Examination - E,W,H*
Wrist Anterior Joint Play Testing - [**Wrist Anterior (Volar/Palmar) Glide**](https://app.clinicalpattern.com/ortho/p1768/)
(a) **Client Position**:
* Sitting with the wrist in neutral, with the forearm on the table and the thumb facing the ceiling.
(b) **Clinician Position**:
* Standing or sitting (as shown) at the client’s side to be assessed.
(c) **Stabilization**:
* The rest of the client’s body on the table serves as a stabilizing force.
* The clinician’s stabilizing hand (left as shown) purchases the distal radius and ulna against the table.
(d) **Movement and Direction of Force**:
* The clinician’s assessing hand (right as shown) purchases the proximal row of carpal bones.
* The clinician uses their assessing hand to glide the proximal row of carpal bones in an anterior (volar/palmar) direction (away from clinician).
(e) **Assessment**:
* Assessment is done for joint play/passive accessory motion, client response, and end- feel.
* Reproduction of concordant pain suggests potential dysfunction. Impaired joint mobility or end-feel may also suggest dysfunction if concordant pain is also reproduced.
36
Wrist Ulnar Glide = **?**
## Footnote
*Examination - E,W,H*
Wrist Ulnar Joint Play Testing - [**Wrist Ulnar Glide**](https://app.clinicalpattern.com/ortho/p1770/)
(a) **Client Position**:
* Sitting with the wrist in neutral, with the forearm supported on the table and fully supinated.
(b) **Clinician Position**:
* Standing or sitting (as shown) at the client’s side to be assessed.
(c) **Stabilization**:
* The rest of the client’s body on the table serves as a stabilizing force.
* The clinician’s stabilizing hand (left as shown) purchases the distal radius and ulna against the table.
(d) **Movement and Direction of Force**:
* The clinician’s assessing hand (right as shown) purchases the proximal row of carpal bones. The clinician uses the assessing hand to glide the proximal row of carpal bones in an ulnar direction (away from clinician).
(e) **Assessment**:
* Assessment is done for joint play/passive accessory motion, client response, and end- feel.
* Reproduction of concordant pain suggests potential dysfunction. Impaired joint mobility or end-feel may also suggest dysfunction if concordant pain is also reproduced.
37
Wrist Radial Glide = **?**
## Footnote
*Examination - E,W,H*
Wrist Radial Joint Play Testing - [**Wrist Radial Glide**](https://app.clinicalpattern.com/ortho/p1771/)
(a) **Client Position**:
* Sitting with the wrist in neutral, with the forearm supported on the table and fully pronated.
(b) **Clinician Position**:
* Standing or sitting (as shown) at the client’s side to be assessed.
(c) **Stabilization**:
* The rest of the client’s body on the table serves as a stabilizing force.
* The clinician’s stabilizing hand (left as shown) purchases the distal radius and ulna against the table.
(d) **Movement and Direction of Force**:
* The clinician’s assessing hand (right as shown) purchases the proximal row of carpal bones.
* The clinician uses the assessing hand to glide the proximal row of carpal bones in a radial direction (away from clinician).
(e) **Assessment**:
* Assessment is done for joint play/passive accessory motion, client response, and end- feel.
* Reproduction of concordant pain suggests potential dysfunction. Impaired joint mobility or end-feel may also suggest dysfunction if concordant pain is also reproduced.
38
Specific Carpal Bone Posterior (Dorsal) Glide = **?**
## Footnote
*Examination - E,W,H*
Carpal Joint Play - **Specific Carpal Bone Posterior (Dorsal) Glide**
(a) **Client Position**:
(b) **Clinician Position**:
(c) **Stabilization**:
(d) **Movement and Direction of Force**:
(e) **Assessment**:
39
Trapeziometacarpal Joint (Thumb) Posterior (Dorsal) Glide = **?**
## Footnote
*Examination - E,W,H*
1st CMC Joint Play Testing - **Trapeziometacarpal Joint (Thumb) Posterior (Dorsal) Glide**:
(a) **Client Position**:
(b) **Clinician Position**:
(c) **Stabilization**:
(d) **Movement and Direction of Force**:
(e) **Assessment**:
## Footnote
* [Dorsal Abduction](https://app.clinicalpattern.com/ortho/p1894/)
* [Palmar Adduction](https://app.clinicalpattern.com/ortho/p1899/)
* [Radial Extension](https://app.clinicalpattern.com/ortho/p1896/)
* [Ulnar Flexion](https://app.clinicalpattern.com/ortho/p1897/)
40
Carpometacarpal Joints 2-5 Posterior (Dorsal) Glide = **?**
## Footnote
*Examination - E,W,H*
2-5th CMC Joint Play Testing - **Carpometacarpal Joints 2-5 Posterior (Dorsal) Glide**:
(a) **Client Position**:
(b) **Clinician Position**:
(c) **Stabilization**:
(d) **Movement and Direction of Force**:
(e) **Assessment**:
41
Metacarpophalangeal Joints 1-5 Glides = **?**
## Footnote
*Examination - E,W,H*
MCP Joint Play Testing - **Metacarpophalangeal Joints 1-5 Glides**:
(a) **Client Position**:
(b) **Clinician Position**:
(c) **Stabilization**:
(d) **Movement and Direction of Force**:
(e) **Assessment**:
42
Interphalangeal Joints 1-5 Glides = **?**
## Footnote
*Examination - E,W,H*
IP Joint Play Testing - **Interphalangeal Joints 1-5 Glides**:
(a) **Client Position**:
(b) **Clinician Position**:
(c) **Stabilization**:
(d) **Movement and Direction of Force**:
(e) **Assessment**:
43
Average Grip Strength:
## Footnote
*Examination - E,W,H*
44
Biceps Squeeze Test = **?**
## Footnote
*Examination - E,W,H*
Distal Biceps Tear - [**Biceps Squeeze Test**](https://www.youtube.com/watch?v=VMHwmfolCwk&t=368s):
(a) **Client Position**:
(b) **Clinician Position**:
(c) **Movement**:
(d) **Assessment**:
* **Positive Test**: Lack of forearm supination as the biceps is squeezed.
## Footnote
**Statistics**:
* SN = 96 (NR)
* SP = 100 (NR)
* Positive (+) LR =
* Negative (-) LR = 0.04
* QUADAS = 9
45
Cozen's Test = **?**
## Footnote
*Examination - E,W,H*
Lateral Epicondylopathy Active Testing - [**Cozen's Test**](https://www.youtube.com/watch?v=VMHwmfolCwk&t=410s)
(a) **Client Position**:
(b) **Clinician Position**:
(c) **Movement**:
(d) **Assessment**:
* **Positive Test**: Reproduction of pain along the lateral epicondyle.
(e) **Clinical Pearl**:
* ECRB is most common; however, other tendons can be pathologic.
* To better provoke ECRB, apply resistance to the 3rd phalanx (***Maudsley’s*** Lateral Epicondylitis Test).
## Footnote
**Statistics**:
* SN =
* SP =
* Positive (+) LR =
* Negative (-) LR =
* QUADAS =
46
Medial Epicondylitis Test = **?**
## Footnote
*Examination - E,W,H*
Medial Epicondylopathy Stretch Testing - [**Medial Epicondylitis Test**](https://www.youtube.com/watch?v=VMHwmfolCwk&t=493s)
(a) **Client Position**:
(b) **Clinician Position**:
(c) **Movement**:
(d) **Assessment**:
* **Positive Test**: Pain at medial epicondyle
(e) **Clinical Pearl**:
* You can use **A**ctive **R**ecruitment or **P**assive **S**tretch to help diagnose both Medial and Lateral Epicondylitis.
* Only the lateral tests have names (**AR**) Cozen, (**AR**) Maudsley, (**PS**) Mills.
## Footnote
**Statistics**:
* SN =
* SP =
* Positive (+) LR =
* Negative (-) LR =
* QUADAS =
47
Varus Stress Test = **?**
## Footnote
*Examination - E,W,H*
Lateral Instability - [**Varus Stress Test**](https://www.youtube.com/watch?v=VMHwmfolCwk&t=533s)
(a) **Client Position**:
(b) **Clinician Position**:
(c) **Movement**:
(d) **Assessment**:
* **Positive Test**: Production of distraction pain laterally and compression pain medially at the joint line and laxity.
## Footnote
**Statistics**:
* SN =
* SP =
* Positive (+) LR =
* Negative (-) LR =
* QUADAS =
48
Valgus Stress Test = **?**
## Footnote
*Examination - E,W,H*
Medial Instability - [**Valgus Stress Test**](https://www.youtube.com/watch?v=VMHwmfolCwk&t=533s)
(a) **Client Position**:
(b) **Clinician Position**:
(c) **Movement**:
(d) **Assessment**:
* **Positive Test**: Production of distraction pain medially and compression pain laterally at the joint line and laxity.
## Footnote
**Statistics**:
* SN = 65 (38-86)
* SP = 50 (7-93)
* Positive (+) LR = 1.3
* Negative (-) LR = 0.7
* QUADAS = 10
49
Moving Valgus Stress Test = **?**
## Footnote
*Examination - E,W,H*
Dynamic Medial Instability - [**Moving Valgus Stress Test**](https://www.youtube.com/watch?v=VMHwmfolCwk&t=603s)
(a) **Client Position**:
(b) **Clinician Position**:
(c) **Movement**:
(d) **Assessment**:
* **Positive Test**: Pain reproduction when the elbow is extended. The highest level of pain should be between 70 and 120 (shear angle)
## Footnote
**Statistics**:
* SN =
* SP =
* Positive (+) LR =
* Negative (-) LR =
* QUADAS =
50
Chair Push Up Test = **?**
## Footnote
*Examination - E,W,H*
Posterior-Lateral Radial Instability - [**Chair Push Up Test**](https://www.youtube.com/watch?v=VMHwmfolCwk&t=652s)
(a) **Client Position**: Seated, with elbows flexed to 90, forearms supinated, and arms abducted to greater than shoulder width.
(b) **Clinician Position**: N/A
(c) **Movement**: The client pushes down on the arms of the chair to rise, exclusively using upper extremity force.
(d) **Assessment**:
* **Positive Test**: Reluctance to extend the elbow fully as the client raises the body up from a chair as a result of apprehension or of complete dislocation.
(e) **Notes**:
* Can also be used for TFCC Instability Testing
## Footnote
**Statistics**:
* SN = 100 (NR)
* SP = (NR)
* Positive (+) LR = (NR)
* Negative (-) LR = (NR)
* QUADAS = 8
51
Tinel's Sign at the Elbow = **?**
## Footnote
*Examination - E,W,H*
Cubital Tunnel Syndrome (Ulnar Neuropathy) - [**Tinel's Sign at the Elbow**](https://www.youtube.com/watch?v=VMHwmfolCwk&t=706s)
(a) **Client Position**:
(b) **Clinician Position**:
(c) **Movement**:
(d) **Assessment**:
* **Positive Test**: Reproduction of symptoms along the ulnar distribution.
## Footnote
**Statistics**:
* SN = 54 (NR)
* SP = 99 (NR)
* Positive (+) LR = 54 (NR)
* Negative (-) LR = 0.46 (NR)
* QUADAS = 6
52
Elbow flexion Test for Cubital Tunnel = **?**
## Footnote
*Examination - E,W,H*
Cubital Tunnel Syndrome (Ulnar Neuropathy) - [**Elbow flexion Test for Cubital Tunnel**](https://www.youtube.com/watch?v=VMHwmfolCwk&t=738s)
(a) **Client Position**:
(b) **Clinician Position**:
(c) **Movement**:
(d) **Assessment**:
* **Positive Test**:
## Footnote
**Statistics**:
* SN = 75 (NR)
* SP = 99 (NR)
* Positive (+) LR = 75 (NR)
* Negative (-) LR = 0.25 (NR)
* QUADAS = 7
53
Wrist Flexion and Median Nerve Compression = **?**
## Footnote
*Examination - E,W,H*
Carpal Tunnel Syndrome - [**Wrist Flexion and Median Nerve Compression**](https://www.youtube.com/watch?v=VMHwmfolCwk&t=779s)
(a) **Client Position**:
(b) **Clinician Position**:
(c) **Movement**:
(d) **Assessment**:
* **Positive Test**: Reproduction of the client's symptoms along the median nerve distribution withim either 20 or 30 seconds.
## Footnote
**Statistics**:
* SN = 86 (80-92)
* SP = 95 (91-99)
* Positive (+) LR = 17.2
* Negative (-) LR = 0.15
* QUADAS = 9
54
Phalen's Test = **?**
## Footnote
*Examination - E,W,H*
Carpal Tunnel Syndrome - [**Phalen's Test**](https://www.youtube.com/watch?v=VMHwmfolCwk&t=813s):
(a) **Client Position**:
(b) **Clinician Position**:
(c) **Movement**:
(d) **Assessment**:
* **Positive Test**: Reproduction or exacerbation of parethesias or anesthesia in the cutaneous distribution of the median nerve in the hand.
## Footnote
**Statistics**:
* SN = (NR)
* SP = (NR)
* Positive (+) LR = (NR)
* Negative (-) LR = (NR)
* QUADAS =
55
Finkelstein's Test = **?**
## Footnote
*Examination - E,W,H*
Stenosing Tendovaginitis - [**Finkelstein's Test**](https://www.youtube.com/watch?v=VMHwmfolCwk&t=862s)
(a) **Client Position**:
(b) **Clinician Position**:
(c) **Movement**:
(d) **Assessment**:
* **Positive Test**: Pain over the abductor pollicis longus (APL) and extensor pollicis brevis (EPB) tendons.
## Footnote
**Statistics**:
* SN = 81 (NR)
* SP = 50 (NR)
* Positive (+) LR = 1.62
* Negative (-) LR = 0.38
* QUADAS = 9
56
Watson Scaphoid Test = **?**
## Footnote
*Examination - E,W,H*
Scapholunate Instability - [**Watson Scaphoid Test**](https://app.clinicalpattern.com/ortho/p1782/#main)
(Scaphoid Instability)
(a) **Client Position**:
(b) **Clinician Position**:
(c) **Movement**:
(d) **Assessment**:
* **Positive Test**: Occurs when there is a subluxation or clunk at the clinician's thumb and a reproduction of pain reported by the client.
## Footnote
**Statistics**:
* SN = (NR)
* SP = (NR)
* Positive (+) LR = (NR)
* Negative (-) LR = (NR)
* QUADAS =
57
Ulnomeniscotriquetral Dorsal Glide = **?**
## Footnote
*Examination - E,W,H*
Ulnomeniscotriquetral Instability - [**Ulnomeniscotriquetral Dorsal Glide or Piano Key Test**](https://app.clinicalpattern.com/ortho/p1892/#main) (TFCC Tear or Triquetral Instability)
(a) **Client Position**:
(b) **Clinician Position**:
(c) **Movement**:
(d) **Assessment**:
* **Positive Test**: Reproduction of pain or laxity in the ulnomeniscotriquetral region.
## Footnote
**Statistics**:
* SN = (NR)
* SP = (NR)
* Positive (+) LR = (NR)
* Negative (-) LR = (NR)
* QUADAS =
58
Ulnar Collateral Ligament Test = **?**
## Footnote
*Examination - E,W,H*
Thumb Instability - [**Ulnar Collateral Ligament Test**](https://app.clinicalpattern.com/ortho/p1765/#main)
(a) **Client Position**:
(b) **Clinician Position**:
(c) **Movement**:
(d) **Assessment**:
* **Positive Test**: Valgus movement greater than 30 degrees.
## Footnote
**Statistics**:
* SN = 94 (NR)
* SP = (NR)
* Positive (+) LR = (NR)
* Negative (-) LR = (NR)
* QUADAS = 8
59
Glind Test = **?**
## Footnote
*Examination - E,W,H*
1st CMC Arthritis - [**Glind Test**](https://www.youtube.com/watch?v=VMHwmfolCwk&t=904s)
(a) **Client Position**:
(b) **Clinician Position**:
(c) **Movement**:
(d) **Assessment**:
* **Positive Test**: Pain at the 1st CMC
(e) **Clinical Pearl**:
* This is the same movement you would use while screening for a scaphoid fracture.
* The difference comes in name, intent, and clinical significance.
## Footnote
**Statistics**:
* SN = (NR)
* SP = (NR)
* Positive (+) LR = (NR)
* Negative (-) LR = (NR)
* QUADAS =
60
Bunnell-Littler Test = **?**
## Footnote
*Examination - E,W,H*
Hand Intrinsic Tightness - [**Bunnell-Littler Test**](https://www.youtube.com/watch?v=VMHwmfolCwk&t=938s)
(a) **Client Position**:
(b) **Clinician Position**:
(c) **Movement**:
(d) **Assessment**:
* **Positive Test**: Less PIP motion with MCP extension = Intrinsic Tightness
## Footnote
**Statistics**:
* SN = (NR)
* SP = (NR)
* Positive (+) LR = (NR)
* Negative (-) LR = (NR)
* QUADAS =
61
ULNT 1: Median Nerve Bias = **?**
## Footnote
*Examination - E,W,H*
Median Neural Tension Test - [**ULNT 1: Median Nerve Bias**](https://app.clinicalpattern.com/special_tests/2081/1104/p1278/)
(a) **Client Position**:
(b) **Clinician Position**:
(c) **Movement**:
(d.1) **Assessment**:
(d.2) **Positive Test**:
* Reproduction of client's symptoms
* Side-to-side differences (reproduces concordant pain on involved side and nonconcordant symptoms on noninvolved side)
* Affected by a distant component: contralateral neck side bending increases symptoms or ipsilateral side bending decreases symptoms.
## Footnote
**Statistics**:
* SN = (NR)
* SP = (NR)
* Positive (+) LR = (NR)
* Negative (-) LR = (NR)
* QUADAS =
62
ULNT 2B: Radial Nerve = **?**
## Footnote
*Examination - E,W,H*
Radial Neural Tension Test - [**ULNT 2B: Radial Nerve**](https://app.clinicalpattern.com/special_tests/2081/1104/p1279/)
(a) **Client Position**:
(b) **Clinician Position**:
(c) **Movement**:
(d.1) **Assessment**:
(d.2) **Positive Test**:
* Reproduction of client's symptoms
* Side-to-side differences (reproduces concordant pain on involved side and noncordant symptoms on noninvolved side).
63
ULNT 3: Ulnar Nerve = **?**
## Footnote
*Examination - E,W,H*
ULNT 3: Ulnar Nerve = [**Ulnar Neural Tension Test**](https://app.clinicalpattern.com/special_tests/2081/1104/p1280/):
(a) **Client Position**:
(b) **Clinician Position**:
(c) **Movement**:
(d.1) **Assessment**:
(d.2) **Positive Test**:
* Reproduction of client's symptoms
* Side-to-side differences (reproduces concordant pain on involved side and noncordant symptoms on noninvolved side).
* Affected by a distant component: Contralateral neck side bending increases symptoms or ipsalateral side bending decreases symptoms.
64
Upper Extremity Myotomes:
* C1-T1 = **?**
## Footnote
*Examination - E,W,H*
[Upper Extremity Myotomes](https://app.clinicalpattern.com/rom_mmt/2580/2608/2608-1/p7413/):
* **C1-2** = Flexion
* **C3** = Side bend
* **C4** = Scap Elevation
* **C5** = GH Abduction
* **C6** = Elbow Flexion
* **C7** = Elbow Extension
* **C8** = Thumb Abduction
* **T1**= 5th Abduction
65
Upper Extremity Reflex Testing = **?**
## Footnote
*Examination - E,W,H*
[Upper Extremity Reflex Testing](https://app.clinicalpattern.com/rom_mmt/2580/2608/2608-1/2608-1-1/p7417/):
* **C5** = Biceps
* **C6** = Brachioradialis
* **C7** = Triceps
* **C1-4** = Scapulohumeral
* **Hoffman's** = Cord
* **Jawjerk** = Brainstem
66
Upper Extremity Sensory Testing = **?**
## Footnote
*Examination - E,W,H*
[Upper Extremity Sensory Testing](https://app.clinicalpattern.com/rom_mmt/2580/2608/2608-1/p7415/):
67
Elbow Snapshot:
* ROM = **?**
* Loose Pack = **?**
* Close Pack = **?**
* Pattern = **?**
* Arthrokinematics = **?**
## Footnote
*Examination - E,W,H*
Elbow Snapshot:
(a) **ROM**:
* Flexion = 150°
* Extension = 0°
* Pronation = 80°
* Supination = 80°
(b.1) **Loose Pack**:
* **Humeroulnar LP** = 70° Flexion & 10° Supination
* **Humeroradial LP** = Full Extension + Supination
* **PRUJ LP** = 70° Flexion & 35° Supination
(b.2) **Closed Pack**:
* **Humeroulnar CP** = Full Extension
* **Humeroradial CP** = 90° Flexion + Slight Supination
* **PRUJ CP** = 5° Supination
(c) **Capsular Pattern**:
* **HU Cap Pattern** = Flexion > Extension
* **HR Cap Pattern** = Flexion > Extension
* **PRUJ Cap Pattern** = Supination > Pronation
(d) **Arthrokinematics**:
* **Humeroulnar** = Concave on Convex
* **Humeroradial** = Concave on Convex
* **PRUJ** = Convex on Concave
68
Wrist Snapshot:
* ROM = **?**
* Loose Pack = **?**
* Close Pack = **?**
* Arthrokinematics = **?**
## Footnote
*Examination - E,W,H*
Wrist Snapshot:
(a) **ROM**:
* Flexion = 80°
* Extension = 70°
* Pronation = 20°
* Supination = 30°
(b.1) **Loose Pack**:
* **DRUJ** = 10° Supination
* **Radiocarpal** = Neutral + Ulnar Dev.
(b.2) **Closed Pack**:
* **DRUJ** = 5° Supination
* **Radiocarpal** = Extension + Radial Dev.
(c) **Arthrokinematics**:
* **PRUJ** = Concave on Convex
* **Radiocarpal** = Convex on Concave
69
Hand Snapshot:
* ROM = **?**
* Loose Pack = **?**
* Close Pack = **?**
* Pattern = **?**
* Arthrokinematics = **?**
## Footnote
*Examination - E,W,H*
Hand Snapshot:
(a.1) **1st CMC ROM**:
* Flexion = 15°
* Extension = 20°
* Abduction = 70°
* Opposition = Tip of 5th base
(a.2) **1st MCP ROM**:
* Flexion = 50°
(a.3) **1st IP ROM**:
* Flexion = 80°
* Extension = 20°
(a.4) **2-5th CMC ROM**:
* Flexion = 90°
* Extension = 45°
* Abduction = 20°
(a.5) **2-5th PIP ROM**:
* Flexion = 100°
(a.6) **2-5th CMC ROM**:
* Flexion = 90°
* Extension = 10°
(b.1) **Loose Pack**:
* **CMC/MCP** = Slight flexion
* **IP** = Slight flexion
(b.2) **Closed Pack**:
* **CMC/MCP** = Fist position
* **IP** = Fist position
(c) **Capsular Pattern**:
* **1st CMC** = Abduction > Extension
* **MCP & IP** = Flexion > Extension
(d) **Arthrokinematics**:
* **All Joints Except...** = Concave on Convex
* **1st CMC** = Saddle Joint - Convex on Concave
