Final Practical Flashcards
Grind Test CMC
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
OA In the thumb
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
FDS/FDP Testing
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
Ulnar impingement sign
elbow on table, palpate over TFCC, then UD rotate forearm
positive is clicking
Ulnar compression test
elbow on table, palpate over TFCC, then UD with axial load, and then rotate forearm
positive is clicking
TFCC Injury
wear and tear
FOOSH
TX: avoid WB at first, isometrics, strengthen other forearm rotators, proprioceptive exercises
Treatment of thumb oA
orthotics
joint protection
adaptive equipment
thumb stabilization,
strengthening the thumb complex with opposition, holding C position, spinning cap
Watson’s test
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
Scapholunate Ligament Injury
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
Froment’s sign
as paper is pulled away by the examiner, thumb with injury will go into IP joint flexion
testing adductor pollicis, ulnar nerve compression
Tx for Ulnar Nerve
positioning (sleeping, sitting at desk)
orthotics, depends on how far along and where compression is at
nerve gliding
e-stim
Wartenburg’s sign
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
Elson’s test
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
Rupture of the central slip can be a cause for
boutinnere deformity
flexion of PIP and extension of DIP
Rupture of central slip MOI
hyperflexion
Rupture of central slip Tx
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
Cozen’s test
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
Mill’s test
Palpate lateral epicondyle with elbow flexed
passively pronate and flex wrist, then extend elbow
positive: pain over lateral epicondyle, testing for lateral epicondylitis
Tennis Elbow Test
support elbow
press down at 3rd digit
positive is pain at lateral epicondyle
testing for tennis elbow
Tennis Elbow
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
Golfer’s Elbow Test
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
Golfer’s Elbow
35 yo and older
overuse
tx: activity modification, soft tissue mobs, isometrics
Varus and Valgus Stress Tests
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
Moving valgus stress test
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
MWMs Tennis Elbow
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
Humeroradial Dorsal/Volar Glides
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
Dorsal glide of radius to increase
elbow extension
Palmar glide of radius to increase
elbow flexion
Interventions for Lateral Tendinopathy
- Limit pain provoking activities
- MWMs
- Serratus and lower trap exercises, and RC cuff for stability
- Stretching of forearm extensors
- Resistance and functional ROM
R Nerve Atrophy
Upper post comp
lower post comp
deep post comp
R Nerve Sensory
Ant: lateral upper arm, superior to antebrachial space. Proximal to MCP of thumb
Post: forearm, elbow, 1-3 digits excluding DIPs
R Nerve Motor
Elbow extension
radial deviation
wrist extension
fist clenching power w/ECRL
finger extension
thumb abduction, extension
supination
R Nerve Special Tests
Wrist Drop presentation = would indicate weak extensors
supination mmt
thumb extension mmt
R Nerve Orthoses
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
R Nerve MOI
spiral groove compression from crutches, alcohol abuse (saturday night palsy), humeral fracture
Post interosseous syndrome: repetitive pronation, forearm extension, and wrist flexion
R Nerve Treatment
SGC: orthosis, PROM for contractures, AROM once muscle function returns
PIS: nerve gliding, positioning, tissue mob
R Nerve Clinical Findings
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
R Nerve Entrapment
between supinator heads (arcade of froshe)
radial/carpal tunnel
spiral groove
U Nerve atrophy
medial anterior compartment
thumb webbing
anterior pinky
dorsal hand
U Nerve sensory
palmar and dorsal 4-5 digits
U Nerve Motor
hand intrinsics, add/abd of digits
flexion of 4/5 digits
thumb adduction
wrist flexion
wrist UD
U Nerve Special tests
froment’s sign
claw hand (late)
flexed elbow for 20 sec
tinel’s at hamate or elbow
wartenbergs
U Nerve Orthoses
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
U Nerve MOI
Cubital tunnel syndrome: elbows on desk, baseball, javelin
Tunnel of Guyon: drills, cycling, arthritis
RARE: blood clots, cysts
U Nerve Clinical Findings
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
U Nerve Treatment
Ulnar nerve gliding
avoid pressure on guyon’s canal
sleeping position
sitting position
possible orthsis
U Nerve Entrapment
cubital tunnel
ulnar level at wrist (tunnel of guyon)
M Nerve Atrophy
anterior compartment, all 3 layers
thumb intrinsics
M Nerve Sensory
lateral pal
palmar digits 1-3, 1/2 4
dorsal DIPs 1-3, 1/2 4
M Nerve Motor
thumb flexion and opposition
flexion of digits 2-3
wrist flexion
wrist RD
pronation
M Nerve Special Tests
Tinel’s
Phalen’s
Reverse Phalen’s
OK sign
M Nerve Orthosis
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
M Nerve Entrapment
Ligament of struthers
lacertus fibrosis
between heads of pronator teres
at origin of FDS
carpal tunnel
M Nerve MOI
Pronator Teres Syndrome: repetitive pronation
the others are compression at the area
M Nerve Carpal Tunnel Syndrome
S/S: worse at night, numbness in fingers, + flick, difficulty with grasp/pinch
CF: Thenar atrophy, + tinel at carpal, +phalen/reverse phalen, sensory intact
M Nerve Anterior Interosseous Syndrome
S/S difficulty writing, pain in proximal 1/3 of forearm
CF: + OK sign, no sensory loss, weakness in fingers 1+2
M Nerve Pronator Teres Syndrome
S/S: Pain in hand and fingers
CF: No weakness in Pronator Teres and ECRB, + Tinel’s at proximal forearm, sensory loss
M Nerve Lacertus Fibrosis
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
