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Morgan E&M > Hand Exam > Flashcards

Hand Exam Flashcards

1
Q

Nerve damage in ape hand

A

Median Nerve

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2
Q

Nerve damage in claw hand

A

Median/ulnar nerve

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3
Q

Nerve damage in bishop’s hand

A

Ulnar nerve

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4
Q

Nerve damage in wrist drop

A

Radial Nerve (extensors don’t work yanno)

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5
Q

What are we observing in appearance for a hand evaluation?

A 
UE/head/neck position
Gross atrophy
Edema
Tone
Scars
Color
Moisture (ew)
Deformed nails
Contractures
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6
Q

What are Bouchard’s nodes?

A

Swelling in PIPs

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7
Q

What are Heberden’s nodes?

A

Swelling in DIPS

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8
Q

What is mallet finger?

A

Straight PIPs, flexed DIP

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9
Q

Swan neck contracture

A

Extended PIP, flexed DIO+P

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10
Q

Boutonnière Contracture

A

Flexed PIP, extended DIP

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11
Q

More than 10 mL difference in volumetric measurements

A

“Archimede principle of water displacement”

Means swelling!

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12
Q

Procedure for edema measurement in hand

A

1- Overfill tank slightly, let water drain
2- Immerse limb slowly until 3rd web hits stop rod, collect displaced water in graduated cylinder
3- Record graduated cylinder volume in mL

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13
Q

For edema measurement, what amount of displaced water represents swelling?

A

More than 10 mL

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14
Q

Variables that decrease accuracy of hand edema measurement

A
  • aerated hose
  • limb motion
  • inconsistency of pressure on stop rod
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15
Q

For all digital measurements keep wrist _______.

Why?

A

Neutral–avoid tension from opposing extrinsic muscle groups

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16
Q

How to perform digital ROM:

A

1- measure mP flexion in intrinsic positive mosition
2- Measure PIP/DIP flexion together with MP in extension
-Stabilized/blocked/isolated ROM (not complete flexion)
3- After flexion measurements, record ext. by asking for composite extension

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17
Q

What is TAM?

A

Sum of active flexion measurements at MP, PIP, DIP, minus active extension deficits

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18
Q

What is TPM?

A

Same as TAM BUUUT passive flexion/extension measurements used

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19
Q

Normal TAM value

A

220-240

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20
Q

Normal TPM measurements

A

240-260

21
Q

Normal Index MCP AROM/PROM

A

0-70, 0-80

22
Q

Normal Index PIP AROM/PROM

A

20-50, 10-70

23
Q

Normal Index DIP AROM/PROM

A

20-50, 10-55

24
Q

Thumb abduction AKA

A

Radial abduction

25
Q

MP Capsular Pattern

A

More restriction in flexion than extension

26
Q

IP capsular pattern

A

More restriction in extension than flexion

27
Q

Wrist capsular pattern

A

Equal loss of DF and flexion

28
Q

CMC capsular pattern

A

Abduction and extension limited…flexion relatively free

29
Q

Middle finger normal mcp arom/prom

A

0-90, 0-90

30
Q

Middle finger PIP arom/prom

A

50-100, 45-110

31
Q

Middle finger DIP arom/prom

A

0-70, 0-70

32
Q

What is volar surface?

A

Palm of hand

33
Q

Passive restriction to extension?

A

Volar plate adhesions, volar skin contracture, bony block, flexion tendon adhesion

34
Q

Passive restriction to flexion indicative of

A

Dorsal skin tightness, extensor tendon scar/tightness

35
Q

Active restraint to extension indicative of

A

Passive restraint/extensor lag

36
Q

Active restraint to flexion indicitive of

A

Passive restraints or flexor tendon rupture/adhesion

37
Q

What can cause active restraint to flexion?

A

Some sort of. Trauma

38
Q

Limited composite passive flexion-pattern:

A

Extensor tendon tightness, dorsal skin tightness

39
Q

Limited composite active flexion with normal composite passive flexion-pattern

A

Flexor tendon adhesion or rupture

40
Q

Oblique Retinacular Ligament Tightness test

A
  • DIP Passively flexed with PIP in extension, then flexion
  • Greater motion with PIP flexion: ligament contracture
  • If DIP joint bends easily with PIP joint flexed but not when extended, then tight/contracted ligament (if DIP is tight in both, then probably a capsular problem)
41
Q

Intrinsic Tightness Test

A
  • Intrinsics on passive stretch (MP extension and IP flexion), then relaxed via MP flexion
  • If PIP can be passively flexed more with MP joint in flexion than extension = positive test for tightness
42
Q

Partial range = 2 for which MMTs

A

Finger abduction/adduction, APL, opposition

43
Q

How to perform dynamometer testing?

A
  • Pt sitting, shoulder adducted at side, elbow flexed 90, wrist in 0-30 extension/ 0-15 ulnar deviation
  • Adjust one of five handle position
  • Perform one squeeze each position/three squeezes in one position–average readings
  • Alternate R/L to avoid fatigue
44
Q

Phalen’s test

A

The swan test for carpel tunnel where you sit there for one minute–pos for parathesias
***median nerve

45
Q

Tinel’s sign

A

Tap over carpal tunnel–positive ulnar nerve impingement if. Parathesias

46
Q

Froment’s sign

A
  • APL/B weakness vs ulnar nerve paralysis
  • Grasp paper between them/radial side of index finger
  • Positive sign = terminal phalanx flexes or mcp hyperextends
47
Q

Finkelstein’s Test (probably not that good)

A
  • Tenosynovitis of AbPL/EPB
  • **deQuervian’s disease
  • fist while holding thumb inside and ulnar deviate
  • positive = pain in area of tendons
48
Q

What is more commonly used– static grip testing or rapid exchange testing?

A

Static grip (usually 3 x each side instead of switching hands back and forth quickly)

Morgan E&M (8 decks)

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