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5 Ortho > Final Practical > Flashcards

Final Practical Flashcards

1
Q

Grind Test CMC

A

Testing for OA in the thumb

hold patient’s thumb between your thumb and index finger and place your opposite hand over CMC joint. Apply axial compression and rotation to the MC base on trapezium

Positive: painful crepitus and/or instability

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2
Q

OA In the thumb

A

most common in women over 50

due to wear and tear
S/S pain at base of thum and into thenars, weakness in grip, loss of web space, ligament laxity, subluxation/shoulder sign

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3
Q

FDS/FDP Testing

A

FDS: flick into extension, should be flaccid. Holding all fingers down except the one being tested

FDP: needs tension, holding DIP and flicking finger

testing integrity of tendons

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4
Q

Ulnar impingement sign

A

elbow on table, palpate over TFCC, then UD rotate forearm

positive is clicking

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5
Q

Ulnar compression test

A

elbow on table, palpate over TFCC, then UD with axial load, and then rotate forearm

positive is clicking

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6
Q

TFCC Injury

A

wear and tear
FOOSH

TX: avoid WB at first, isometrics, strengthen other forearm rotators, proprioceptive exercises

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7
Q

Treatment of thumb oA

A

orthotics
joint protection
adaptive equipment
thumb stabilization,

strengthening the thumb complex with opposition, holding C position, spinning cap

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8
Q

Watson’s test

A

thumb of one hand in the palmar aspect of scaphoid and the index finger on the radial tubercle dorsally, with wrist in UD

maintianing firm pressure, push hand into RD.

Positive: proximal pole of scaphoid will jump over the radius with a thunk/clunk

testing for scaphoid instability

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9
Q

Scapholunate Ligament Injury

A

FOOSH
pain in rest, pain with weightbearing, decreased grip, popping

TX: dart thrower, wrist proprioception (tennis ball on racket, rain stick.
also orthosis in thumb spica for 3-8 weeks

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10
Q

Froment’s sign

A

as paper is pulled away by the examiner, thumb with injury will go into IP joint flexion

testing adductor pollicis, ulnar nerve compression

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11
Q

Tx for Ulnar Nerve

A

positioning (sleeping, sitting at desk)
orthotics, depends on how far along and where compression is at
nerve gliding
e-stim

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12
Q

Wartenburg’s sign

A

have patient place hand on table, flat. Spread fingers and ask them to bring their fingers back together

positive: pinky is unable to adduct or compensates by bringing other fingers towards pinky

does not tell us where the ulnar nerve is compressed

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13
Q

Elson’s test

A

examiner passively flexes the PIP joint to 90° over the edge of table and asks the patient to attempt active extension of PIP joint while examiner resists PIP joint extension

acute rupture of central slip results in no extension power being felt at the pip joint and significant extension power produced at DIP

testing rupture of central slip

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14
Q

Rupture of the central slip can be a cause for

A

boutinnere deformity

flexion of PIP and extension of DIP

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15
Q

Rupture of central slip MOI

A

hyperflexion

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16
Q

Rupture of central slip Tx

A

acute = immobilize in PIP extension for 6 weeks. Perform oblique retinacular stretches(stretching the DIP joint)
gradual mobilization

contracting contractures with serial casting for chronic

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17
Q

Cozen’s test

A

stabilizing at elbow with forearm in pronation with elbow extended
apply flexion force, patient tries to extend

psotive: pain over lateral epicondyle
testing for lateral epicondylitis

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18
Q

Mill’s test

A

Palpate lateral epicondyle with elbow flexed
passively pronate and flex wrist, then extend elbow

positive: pain over lateral epicondyle, testing for lateral epicondylitis

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19
Q

Tennis Elbow Test

A

support elbow
press down at 3rd digit

positive is pain at lateral epicondyle
testing for tennis elbow

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20
Q

Tennis Elbow

A

MOI: overuse involving eccentric overload at origin of common extensor tendon, usually ECRB

often complain of pain with gripping or decreased grip strength. Point tenderness on lateral epicondyle

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21
Q

Golfer’s Elbow Test

A

palpate medial epicondyle, with elbow flexed, in pronation, with wrist neutral

passively supinate forearm, extend the elbow and wrist

positive = pain over medial epicondyle of humerus

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22
Q

Golfer’s Elbow

A

35 yo and older
overuse

tx: activity modification, soft tissue mobs, isometrics

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23
Q

Varus and Valgus Stress Tests

A

Used as an assessment for LCL and MCL, looking for laxity or pain

Stabilize elbow by holding humerus firmly, and flex elbow to about 5°
place other hand above wrist, abducting and aducting forearm

expect to feel bone to bone

can flex elbow to 25° to test UCL using valgus stress, which would have soft end feel

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24
Q

Moving valgus stress test

A

standing, arm abducted to 100 and elbow flexed fully
create and maintain valgus stress, quickly extend patient’s elbow

reproudction of pain between 120 to 170 indicates positive injury of MCL

HIGH snout and HIGH spin

25
Q

MWMs Tennis Elbow

A

pts palm down, stabilize humerus with proximal hand, wrist with distal hand

lateral glude using strap just distsal to elbow joint and over shoulder nearest to patients head

patient performs gripping during mob, wrist extension

10-15 reps at 30, 60, 90 of elbow flexion

26
Q

Humeroradial Dorsal/Volar Glides

A

Supine, elbow extended and supinated

stabilize humerus with hand that is on medial side f pts arm. Place palmar surface of your lateral hand on palmar aspect ad your fingers on dorsal aspect of radial head

force: move radial head dorsally with heel of your hand or palmarly with fingers

27
Q

Dorsal glide of radius to increase

A

elbow extension

28
Q

Palmar glide of radius to increase

A

elbow flexion

29
Q

Interventions for Lateral Tendinopathy

A
  1. Limit pain provoking activities
  2. MWMs
  3. Serratus and lower trap exercises, and RC cuff for stability
  4. Stretching of forearm extensors
  5. Resistance and functional ROM
30
Q

R Nerve Atrophy

A

Upper post comp
lower post comp
deep post comp

31
Q

R Nerve Sensory

A

Ant: lateral upper arm, superior to antebrachial space. Proximal to MCP of thumb

Post: forearm, elbow, 1-3 digits excluding DIPs

32
Q

R Nerve Motor

A

Elbow extension
radial deviation
wrist extension
fist clenching power w/ECRL
finger extension
thumb abduction, extension
supination

33
Q

R Nerve Special Tests

A

Wrist Drop presentation = would indicate weak extensors
supination mmt
thumb extension mmt

34
Q

R Nerve Orthoses

A

Static for acute injuries

Functional for late chronic, no possibility of regaining motion on their own

Static progressive = beginning to develop contractures

Dynamic = protection with movement; proliferative stage

35
Q

R Nerve MOI

A

spiral groove compression from crutches, alcohol abuse (saturday night palsy), humeral fracture

Post interosseous syndrome: repetitive pronation, forearm extension, and wrist flexion

36
Q

R Nerve Treatment

A

SGC: orthosis, PROM for contractures, AROM once muscle function returns

PIS: nerve gliding, positioning, tissue mob

37
Q

R Nerve Clinical Findings

A

PIS: weakness in wrist and fingers with no sensory impacts but pain at lateral epicondyle. possible wrist drop. Deep pain in post forearm and difficulty making a fist.

SCG: weakness/paresthesias throughout, wrist drop

38
Q

R Nerve Entrapment

A

between supinator heads (arcade of froshe)
radial/carpal tunnel
spiral groove

39
Q

U Nerve atrophy

A

medial anterior compartment
thumb webbing
anterior pinky
dorsal hand

40
Q

U Nerve sensory

A

palmar and dorsal 4-5 digits

41
Q

U Nerve Motor

A

hand intrinsics, add/abd of digits
flexion of 4/5 digits
thumb adduction
wrist flexion
wrist UD

42
Q

U Nerve Special tests

A

froment’s sign
claw hand (late)
flexed elbow for 20 sec
tinel’s at hamate or elbow
wartenbergs

43
Q

U Nerve Orthoses

A

Claw hand –> Serial static for contracture correcting, static progressive for increase ROM and motion, functional to then have use of hand again

Static –> acute injury, dynamic if motion is needed along with protection

44
Q

U Nerve MOI

A

Cubital tunnel syndrome: elbows on desk, baseball, javelin

Tunnel of Guyon: drills, cycling, arthritis
RARE: blood clots, cysts

45
Q

U Nerve Clinical Findings

A

CTS: pain forearm, numbness in pinky, atrophy of hand, instrinsics, no deep tunnel reflex

TOG: numbness/pain in distal ulnar. hand intrinsics of pinky are normal. Worse at night, palmar hand pain, painful wrist extension

46
Q

U Nerve Treatment

A

Ulnar nerve gliding
avoid pressure on guyon’s canal
sleeping position
sitting position
possible orthsis

47
Q

U Nerve Entrapment

A

cubital tunnel
ulnar level at wrist (tunnel of guyon)

48
Q

M Nerve Atrophy

A

anterior compartment, all 3 layers
thumb intrinsics

49
Q

M Nerve Sensory

A

lateral pal
palmar digits 1-3, 1/2 4
dorsal DIPs 1-3, 1/2 4

50
Q

M Nerve Motor

A

thumb flexion and opposition
flexion of digits 2-3
wrist flexion
wrist RD
pronation

51
Q

M Nerve Special Tests

A

Tinel’s
Phalen’s
Reverse Phalen’s
OK sign

52
Q

M Nerve Orthosis

A

Static or dynamic –> acute injury

Chronic:
Serial static for mobilizing, contracture correction
Static progressive increase ROM and motion
functional to then have use of hand again

53
Q

M Nerve Entrapment

A

Ligament of struthers
lacertus fibrosis
between heads of pronator teres
at origin of FDS
carpal tunnel

54
Q

M Nerve MOI

A

Pronator Teres Syndrome: repetitive pronation
the others are compression at the area

55
Q

M Nerve Carpal Tunnel Syndrome

A

S/S: worse at night, numbness in fingers, + flick, difficulty with grasp/pinch

CF: Thenar atrophy, + tinel at carpal, +phalen/reverse phalen, sensory intact

56
Q

M Nerve Anterior Interosseous Syndrome

A

S/S difficulty writing, pain in proximal 1/3 of forearm

CF: + OK sign, no sensory loss, weakness in fingers 1+2

57
Q

M Nerve Pronator Teres Syndrome

A

S/S: Pain in hand and fingers

CF: No weakness in Pronator Teres and ECRB, + Tinel’s at proximal forearm, sensory loss

58
Q

M Nerve Lacertus Fibrosis

A

S/S: pain in median n distribution, deep pain at ligament of struthers (lateral upper arm near elbow)

CF: weakness in all median muscles, benediction’s hand, + Tinel at distal humerus

5 Ortho (14 decks)

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