Hand Pain Wk 5 Flashcards
C5 Nerve Root
Disc level: C4 Muscle test: deltoid, axillary nerve biceps, musculocutaneous nerve Reflex: Biceps Sensation: lateral arm
C6 Nerve Root
Disc Level: C5
Muscle Test:
wrist extension (flexor carpi radialis longus and brevis and extensor carpi ulnaris, radial nerve)
Reflex: brachioradialis
Sensation: lateral forearm thumb and index fingers
C7 Nerve Root
Disc level: C6
Muscle test:
-elbow extension (triceps, radial nerve)
- wrist flexion (flexor carpi radialis, median nerve and flexor carpi ulnaris, ulnar nerve)
-finger extension (extensor digitorum communis, extensor indicis profundus, extensor digiti minimi, radial nerve)
Reflex: Triceps
Sensation: palm and middle finger
C8 Nerve Root
Disc level: C7
Muscle Test:
finger flexion (flexor digitorum superficialis, flexor digitorum profundus, lumbricals, median and ulnar nerves)
Reflex: NONE
Sensation: 4th 5th digitsT1 Nerve Root
Disc Level: T1
Muscle tests:
-finger abduction (dorsal interossei, ulnar nerve)
-finger adduction (palmar interossei, ulnar nerve)
Reflex: NONE
Sensation: medial elbow
Bony Palpation of Cervical Spine
Anterior
hyoid bone
thyroid cartilage
first cricoid ring
mandible
Posterior
occiput
Inion (EOP)
superior nuchal line
mastoid process
spinous processes
facet jointsCervical Soft Tissue Palpation
SCM anterior lymph chain posterior lymph chain thyroid gland carotid pulse supraclavicular fossa traps greater occipital nerves superior nuchal ligament
Cervical Spine ROM
flexion 50
extension 60
lateral flexion 45
rotation 80
Foraminal Compression Test
seated and standing behind. clasp hands over head and exert gradual downward pressure. do straight, left, right
-exacerbation of localized cervical pain indicates foraminal encroachment or facet pathology without nerve root compression. exacerbation of cervical pain with a radicular component indicates foraminal encroachment or facet pathology with nerve root compression
Cervical Distraction Test
seated. grasp hands and exert upward pressure
- diminished or absence of pain indicates foraminal encroachment (local pain diminishes), nerve root compression (radicular pain diminishes) or cervical pain increases indicating muscular strain, ligamentous sprain, myospasm, facet capsulitis
Spinal Percussion Test
seated with slight head flexion. percuss each spinous and the associated musculature with hammer
-local pain indicating possible fractured vertebrae, ligamentous involvement (spinous pain), and muscular involvement (muscular pain) or radiating pain indicating possible disc pathology
Shoulder Depression Test
seated. stabilize and laterally flex head, push down on shoulder
- localized pain on the side being testing indicates dural sleeve adhesion, muscular adhesion or contracture, spasm, or ligamentous injury. radiating pain on the side being tested indicates neurovascular bundle compression, dural sleeve adhesions or TOS. Radicular pain opposite side being tested indicates foraminal encroachment with nerve root compression
Valsalva
bear down as if having bowel movement
-radiating pain from the site of lesion (usually recreating the complaint in cervical or lumbar area of the spine) indicates space occupying lesion
Swallowing test
watch them swallow
-difficulty swallowing indicates space occupying lesion at anterior portion of cervical spine, possibly esophageal or pharyngeal injury, anterior disc defect, muscle spasm, or osteophytes.
Soto-Hall
- supine, flex head toward chest while exerting downward pressure on patients sternum with knife edge
- generalized pain in cervical region, which may extend down to T2 indicates non specific test for structural integrity of cervical region
Kernig Sign
supine. flex hip and knee to 90d. then slowly extend leg
- inability to fully extend leg and/or pain (usually in the neck region) indicates meningeal irritation/ meningitis.
O-Donoghue Maneuver
seated. passive ROM. Then each ROM against resistance.
- pain during passive ROM indicates ligamentous sprain, pain during resisted ROM indicates muscle/tendo strain
L’Hermittie Sign
sitting or supine. flexes the head toward chest or doctor actively flexes patients head to chest
-electric shock-like sensations down the spine and/or through extremities indication dural irritation, severe spinal cord injury or degeneration
Brudzinski Sign
supine, flex patients head to chest
-involuntary knee flexion indicates meningeal irritation or nerve root lesion
Jackson Compression
seated, dr standing behind. laterally flex head and then exert downward pressure, each side
-exacerbation of localized cervical pain indicates foraminal encroachment without nerve root pressure or facet pathology. exacerbation of cervical pain with radicular component indicates foraminal encroachment with nerve root compression
Maximal Cervical Compression
pt seated, dr standing behind. tell the patient to rotate the head and hyperextend the neck
-pain on concave side indicates foraminal encroachment. if radicular component present consider nerve root compression
Bakody Sign aka
aka shoulder abduction test
seated, tell pt to place the palm of affected side flat on top of head
-decrease or absence of radiating pain indicates cervical foraminal compression, nerve root entrapment
Bony Palpation of Elbow
medial epicondyle medial supracondylar line of humerus groove of ulnar nerve trochlea olecranon olecranon fossa lateral epicondyle lateral supracondylar line of humerus radial head
Soft Tissue Palpation of Elbow
ulnar nerve
wrist flexor muscles
pronator teres
flexor carpi radialis
palmaris longus
flexor carpi ulnaris
medial collateral ligament
supracondylar lymph nodes
brachial artery
triceps muscle
lateral collateral ligament
Biceps muscle
olecranon bursa
elbow flexor muscles
brachioradialis
extensor carpi radialis longus
extensor carpi radialis brevisElbow ROM
flexion 150
extension 0
supination/pronation 80
Medial/ Lateral colllateral ligament test akas
aka abduction/adduction stress
-excessive gapping and/or pain indicates medial/latreal collateral ligament instability
Tinel Elbow Sign
with hammer, tap ulnar groove
-pain and/or tenderness at the site being tapped and paresthesia in the ulnar nerve distribution area fingers 4,5 indicates neuroma of ulnar nerve
Cozen Test
pt makes fist and wrist extension. resists as flexion stress is applied
-pain over lateral epicondyle indicates lateral epicondylitis aka tennis elbow
Mills Test
pt seated at edge of table rest with fingers, wrist, and elbow flexed, forearm supinated. with smooth continuous motion thru internal rotation.
-pain over lateral epicondyle indicates lateral epicondylitis or tennis elbow
Golfer Elbow Test
arm extended, fist up toward face. try to pull down, pt restists
-pain over medial epicondyle indicates medial epicondylitis
Bony Palpation of Wrist
radial styloid process scaphoid lunate listers tubercle triquetrium pisiform trapezium trapezoid capitate hook of hamate ulnar styloid process metacarpals phalanges
Soft tissue palpation of Wrist
ulnar artery radial artery palmaris longus tendon carpal tunnel region thenar eminence hypothenar eminence palmar aponeurosis tissues surrounding proximal and distal interphalangeal joints distal tufts
ROM of wrist and hand
wrist flexion 80
wrist extension 70
ulnar deviation 30
radial deviation 20
finger abduction, adduction, flexion, extension
thumb flexion, extension, opposition, adduction, abduction
Tinel Wrist
wrist supinated. tap over palmar surface
-reproduction of pain, tenderness and/or parasthesia in the medan nerve distribution area (thumb, 2, 3 and lateral 4th) indicates median neuritis, possibly carpal tunnel syndrome
Phalen, Reverse Phalen, Prayer
holds for 60 sec or until pain
-reproduction of pain and/or parasthesia in the median nerve distribution area (digits 1,2,3 and lateral 4) indicates median neuritis possibly carpal tunnel syndrome
Finkelstein Test
thumb in, make fist, tip down
-pain distal to radial styloid indicates stenosing tenosynovitis of the abductor pollicis longus and extensor pollicis brevis tendons aka DeQuervains disease
Bunnel- Littler Test
with metacarpophalangeal joint in extension, try and flex proximal joint. if no, then place in flexion and try again
-flexion of the proximal interphalangeal joint cannot be achieved indicates joint capsule contracture. Flexion of proximal interphalangeal joint is achieved indicates tight intrinsic muscles
Retinacular Test
same as Bunnel- Littler
-flexion of distal joint cannot be achieved indicates joint capsule contracture. flexion of distal joint is achieved than tight retinacular ligament
Allen Test
one hand above head, other palm up on leg. and make fists for 60 secs. Occlude radial and ulnar arteries, lower, open one, check color. do again, open the other artery.
-a delay of more than 10 secs in returning of reddish color to the hand indicates radial or ulnar artery insufficiency. The artery held is not the artery being tested.
Lymph nodes of head and neck
checking for size, shape, consistency, mobility, and condition
occipital postauricular preauricular tonsilar submandibular submental facial anterior cervical chain posterior cervical chain supraclavicular
Roos Test aka?
aka Elevated arm stress test
seated. bring arms and elbows to 90. open and close fists rapidly up to 3 min
-ischemic pain, heaviness of arms, or numbness and tingling of hand indicates thoracic outlet syndrome on side involved
Adsons Test aka?
aka scalene maneuver and scalenus anticus test
seated. establish radial pulse. then bring arm straight and back past body. tell patient to look up(brings scalenes over neurovascular bundle) then rotate to currently tested shoulder. then take breath and hold. then turn and look to other side.
-pain and/or parathesia, decreased or absent radial pulse, pallor indicates compression of neurovascular bundle by scalenus anticus or cervical rib
Halstead Maneuver
seated. find radial pulse. traction arm downward. have patient look up. deep breath. turn and look away from me
- pain and/or parasthesia, decreased or absent pulse, pallor indicates compression of the neurovascular bundle by scalenus anterior or cervical rib
Eden aka?
aka Costoclavicular manuever
seated. establish radial pulse. tell patient to sit up, shoulders back, chest out, touch chin to chest and hold breath
-pain and/or parathesia, decreased or absent pulse, pallor indicates compression of the neurovascular bundle between the clavicle and first rib
Hyperabduction maneuver aka?
aka Wright Test
establish radial pulse and slowly hyperabduct the arm
-pain and/or parathesia, decreased or absent pulse, pallor indicates compression of the axillary artery by pectoralis minor or coracoid process, thoracic outlet syndrome
Fromet Paper sign
pt grips paper between fingers
-unable to maintain grip indicaes ulnar nerve paraylsis
Bracelet Test
seated. mild compressive pressure to dorsum of wrist. pt attempts to make fist
- acute forearm, wrist and hand pain significant for RA
Naffziger Test
seated. occlude both jugular veins for 30 secs. then pt coughs deeply. this is contraindicated for elderly.
- radicular pain typically in lumbars, indicates space occupying lesion
