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CLET > Hand Pain Wk 5 > Flashcards

Hand Pain Wk 5 Flashcards

1
Q

C5 Nerve Root

A 
Disc level: C4
Muscle test: 
   deltoid, axillary nerve
   biceps, musculocutaneous nerve
Reflex: Biceps
Sensation: lateral arm
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2
Q

C6 Nerve Root

A

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

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3
Q

C7 Nerve Root

A

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

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4
Q

C8 Nerve Root

A 
Disc level: C7
Muscle Test:
    finger flexion (flexor digitorum superficialis, flexor digitorum profundus, lumbricals, median and ulnar nerves)
Reflex: NONE
Sensation:  4th 5th digits
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5
Q

T1 Nerve Root

A

Disc Level: T1
Muscle tests:
-finger abduction (dorsal interossei, ulnar nerve)
-finger adduction (palmar interossei, ulnar nerve)
Reflex: NONE
Sensation: medial elbow

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6
Q

Bony Palpation of Cervical Spine

A 
Anterior
    hyoid bone
    thyroid cartilage
    first cricoid ring
    mandible
Posterior
    occiput
    Inion (EOP)
    superior nuchal line
    mastoid process
    spinous processes
    facet joints
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7
Q

Cervical Soft Tissue Palpation

A 
SCM
anterior lymph chain
posterior lymph chain
thyroid gland
carotid pulse
supraclavicular fossa
traps
greater occipital nerves
superior nuchal ligament
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8
Q

Cervical Spine ROM

A

flexion 50
extension 60
lateral flexion 45
rotation 80

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9
Q

Foraminal Compression Test

A

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

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10
Q

Cervical Distraction Test

A

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

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11
Q

Spinal Percussion Test

A

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

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12
Q

Shoulder Depression Test

A

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

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13
Q

Valsalva

A

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

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14
Q

Swallowing test

A

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.

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15
Q

Soto-Hall

A
  • 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
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16
Q

Kernig Sign

A

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.

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17
Q

O-Donoghue Maneuver

A

seated. passive ROM. Then each ROM against resistance.

- pain during passive ROM indicates ligamentous sprain, pain during resisted ROM indicates muscle/tendo strain

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18
Q

L’Hermittie Sign

A

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

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19
Q

Brudzinski Sign

A

supine, flex patients head to chest

-involuntary knee flexion indicates meningeal irritation or nerve root lesion

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20
Q

Jackson Compression

A

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

21
Q

Maximal Cervical Compression

A

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

22
Q

Bakody Sign aka

A

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

23
Q

Bony Palpation of Elbow

A 
medial epicondyle
medial supracondylar line of humerus
groove of ulnar nerve
trochlea
olecranon
olecranon fossa
lateral epicondyle
lateral supracondylar line of humerus
radial head
24
Q

Soft Tissue Palpation of Elbow

A 
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 brevis
25
Q

Elbow ROM

A

flexion 150
extension 0
supination/pronation 80

26
Q

Medial/ Lateral colllateral ligament test akas

A

aka abduction/adduction stress

-excessive gapping and/or pain indicates medial/latreal collateral ligament instability

27
Q

Tinel Elbow Sign

A

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

28
Q

Cozen Test

A

pt makes fist and wrist extension. resists as flexion stress is applied

-pain over lateral epicondyle indicates lateral epicondylitis aka tennis elbow

29
Q

Mills Test

A

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

30
Q

Golfer Elbow Test

A

arm extended, fist up toward face. try to pull down, pt restists

-pain over medial epicondyle indicates medial epicondylitis

31
Q

Bony Palpation of Wrist

A 
radial styloid process
scaphoid
lunate
listers tubercle
triquetrium
pisiform
trapezium
trapezoid
capitate
hook of hamate
ulnar styloid process
metacarpals
phalanges
32
Q

Soft tissue palpation of Wrist

A 
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
33
Q

ROM of wrist and hand

A

wrist flexion 80
wrist extension 70
ulnar deviation 30
radial deviation 20
finger abduction, adduction, flexion, extension
thumb flexion, extension, opposition, adduction, abduction

34
Q

Tinel Wrist

A

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

35
Q

Phalen, Reverse Phalen, Prayer

A

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

36
Q

Finkelstein Test

A

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

37
Q

Bunnel- Littler Test

A

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

38
Q

Retinacular Test

A

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

39
Q

Allen Test

A

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.

40
Q

Lymph nodes of head and neck

A

checking for size, shape, consistency, mobility, and condition

occipital
postauricular
preauricular
tonsilar
submandibular
submental
facial
anterior cervical chain
posterior cervical chain
supraclavicular
41
Q

Roos Test aka?

A

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

42
Q

Adsons Test aka?

A

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

43
Q

Halstead Maneuver

A

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

44
Q

Eden aka?

A

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

45
Q

Hyperabduction maneuver aka?

A

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

46
Q

Fromet Paper sign

A

pt grips paper between fingers

-unable to maintain grip indicaes ulnar nerve paraylsis

47
Q

Bracelet Test

A

seated. mild compressive pressure to dorsum of wrist. pt attempts to make fist
- acute forearm, wrist and hand pain significant for RA

48
Q

Naffziger Test

A

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

CLET (9 decks)

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