Hand therapy: Principles of Examination Flashcards
What are the joints of the hands?
CMC: Carpometacarpal
MP: Metacarpophalangeal
PIP: Proximal Interphalangeal
DIP: Distal Interphalangeal
Redraw Bony anatomy of wrist
Some Lovers Try Positions That They Can’t Handle
Describe the mechanisms of long finger flexors
- FDP mass muscle action to DIP joints
- Independent finger flexion provided by FDS on PIP joints
- FDP goes through FDS
Recall the extensor compartments, and the extensor tendons
1: THUMB- APL, EPB
2. ECRL, ECRB - radial wrist extensors
3. EPL
4. EDC
5. EDM
6: ECU (subsheath connects to wrist capsule)
Describe the long finger extensors
- Thumb, Index and Little finger independent extensor
- EPL, EI, EDM
Which fingers have two extensors
- IF & LF
- EDC and EI
- EDC and EDM: rupture of either lags extension
Recall the intrinsic muscles.
Central intrinsics: Interossei (Dorsal and palmar), Lumbricals
Peripheral intrinsics: Thenar & Hypothenar
Intrinsics flex the MP, extends the IPs, abduct and adduct fingers
Review the pulley system of the hand
Completed?
What are the principles of subjective assessment
- Complaint
- History
- Mechanism of injury
- Functional use
- Hand dominance
- PMHx
- Social issues, sport, music
- Post surgery documentation/discussions
What are the principles of objective assessment?
- Posture
- Inspection/observation
- Sensation
- ROM
- Strength
- Palpation and provocation tests
- Review investigations
What are all the structures to be mindful of?
- Skin
- Tendons
- Muscles
- Nerves and blood vessels
- Joints and ligaments
- Bones
What are things to look for during observation?
- Posture
- Deformity
- Skin condition
- Oedema
- Wastng
- Hand function
What are the stages of wound healing?
- Inflammatory
- Proliferation
- Remodelling
- Recall their duration
What are the brief assessment steps to identify a hand fracture?
- MOI
- Cautious palpation
- AROM
- XRAY
Generally XR first prior to palpation
What are methods for oedema measurement?
- Circumferential
- Volume meter
Hand Fracture: What are methods of measuring ROM?
- Goniometer
- Distance to DPC - less accurate
Summarise the assessment for hand fracture
- Assess finger alignment
- Review XR
- Assess AROM
- Assess F and E tendon function
- Assess appropriate ligaments
- Assess sensory function
- Measure strength: When appropriate after tissue has healed
What are methods of measuring strength?
- Grip: HHD
- Pinch: lateral, two point, three point
- Muscle chart
What are ligament considerations when managing an MCP injury
- Maintain length of collateral ligaments
- immobilise in lengthened position - MCP flexion
What are ligament considerations when managing IP joint injuries?
- PIP flexion contracture so have to keep PIP in extension
- Important to maintain length of volar plate
When observing an extensor tendon injury what should you do immediately?
Splint and x-ray
Flexor: surgery within first 2 weeks
Recall the biomechanics of mallet finger?
- tendon at DIP injury
- All ext pull goes to central slip and hyperextends PIP
- Swan neck deformity
How can you differentiate between FDP AND FDS function
FDP: test DIP
FDS: trap other fingers, bend untrapped finger
How can you differentiate between FDP AND FDS function
FDP: test DIP
FDS: trap other fingers, bend untrapped finger
