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PHTY APPB > Hand therapy: Principles of Examination > Flashcards

Hand therapy: Principles of Examination Flashcards

1
Q

What are the joints of the hands?

A

CMC: Carpometacarpal
MP: Metacarpophalangeal
PIP: Proximal Interphalangeal
DIP: Distal Interphalangeal

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2
Q

Redraw Bony anatomy of wrist

A

Some Lovers Try Positions That They Can’t Handle

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3
Q

Describe the mechanisms of long finger flexors

A
  • FDP mass muscle action to DIP joints
  • Independent finger flexion provided by FDS on PIP joints
  • FDP goes through FDS
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4
Q

Recall the extensor compartments, and the extensor tendons

A

1: THUMB- APL, EPB
2. ECRL, ECRB - radial wrist extensors
3. EPL
4. EDC
5. EDM
6: ECU (subsheath connects to wrist capsule)

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5
Q

Describe the long finger extensors

A
  • Thumb, Index and Little finger independent extensor

- EPL, EI, EDM

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6
Q

Which fingers have two extensors

A
  • IF & LF
  • EDC and EI
  • EDC and EDM: rupture of either lags extension
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7
Q

Recall the intrinsic muscles.

A

Central intrinsics: Interossei (Dorsal and palmar), Lumbricals
Peripheral intrinsics: Thenar & Hypothenar

Intrinsics flex the MP, extends the IPs, abduct and adduct fingers

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8
Q

Review the pulley system of the hand

A

Completed?

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9
Q

What are the principles of subjective assessment

A
  • Complaint
  • History
  • Mechanism of injury
  • Functional use
  • Hand dominance
  • PMHx
  • Social issues, sport, music
  • Post surgery documentation/discussions
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10
Q

What are the principles of objective assessment?

A
  • Posture
  • Inspection/observation
  • Sensation
  • ROM
  • Strength
  • Palpation and provocation tests
  • Review investigations
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11
Q

What are all the structures to be mindful of?

A
  • Skin
  • Tendons
  • Muscles
  • Nerves and blood vessels
  • Joints and ligaments
  • Bones
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12
Q

What are things to look for during observation?

A
  • Posture
  • Deformity
  • Skin condition
  • Oedema
  • Wastng
  • Hand function
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13
Q

What are the stages of wound healing?

A
  • Inflammatory
  • Proliferation
  • Remodelling
  • Recall their duration
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14
Q

What are the brief assessment steps to identify a hand fracture?

A
  • MOI
  • Cautious palpation
  • AROM
  • XRAY

Generally XR first prior to palpation

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15
Q

What are methods for oedema measurement?

A
  • Circumferential

- Volume meter

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16
Q

Hand Fracture: What are methods of measuring ROM?

A
  • Goniometer

- Distance to DPC - less accurate

17
Q

Summarise the assessment for hand fracture

A
  • 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
18
Q

What are methods of measuring strength?

A
  • Grip: HHD
  • Pinch: lateral, two point, three point
  • Muscle chart
19
Q

What are ligament considerations when managing an MCP injury

A
  • Maintain length of collateral ligaments

- immobilise in lengthened position - MCP flexion

20
Q

What are ligament considerations when managing IP joint injuries?

A
  • PIP flexion contracture so have to keep PIP in extension

- Important to maintain length of volar plate

21
Q

When observing an extensor tendon injury what should you do immediately?

A

Splint and x-ray

Flexor: surgery within first 2 weeks

22
Q

Recall the biomechanics of mallet finger?

A
  • tendon at DIP injury
  • All ext pull goes to central slip and hyperextends PIP
  • Swan neck deformity
23
Q

How can you differentiate between FDP AND FDS function

A

FDP: test DIP
FDS: trap other fingers, bend untrapped finger

24
Q

How can you differentiate between FDP AND FDS function

A

FDP: test DIP
FDS: trap other fingers, bend untrapped finger

25
Q

What must you notice about tendon repairs on operation reports to dictate management?

A

Tendon repair type? How many strands

26
Q

When can you test strength?

A

Flexor tendon: No grip test < 8 weeks

Fracture: < 6 weeks

27
Q

What are common thumb injuries?

A
  • DeQuervains
  • CMC OA
  • MP UCL injury
  • Scaphoid #
28
Q

What are special tests for thumb: dorsal radial aspect?

A
  • Palpate snuffbox
  • Palpate intersection syndrome
  • Palpate superficial radial nerve
  • Finklesteins test
  • Grind test (CMC)
  • Thumb UCL test
29
Q

When do you test for pinch strength?

A
  • When no to little pain
  • UCL/ CMC OA
  • FPL tronger
  • IP ext = less grip strength
30
Q

What are you testing for during sensibility testing

A
  • Distinguish between loss of sensation from altered sensation
  • Mapping, monofilaments
  • Localisation
  • 2 point discrimination
31
Q

What is Moberg Pickup test and Shape texture identification?

A
  • Moberg pick up test: different objects

- STI: different shapes on a plate thing

32
Q

What are 3 important wrist ligaments? + complex

A
  • Intrinsic ligaments
  • Scapholunate ligament
  • Lunotriquetral
  • TFCC: triangular Fibrocartilage complex
33
Q

What may occur due to an injury of a major wrist ligament?

A

Wrist alignment may be lost- collapse of carpal bones

- TFCC injury- DRUJ alignment/stability

34
Q

What may occur due to an injury of a major wrist ligament?

A

Wrist alignment may be lost- collapse of carpal bones

- TFCC injury- DRUJ alignment/stability

35
Q

What are special tests for the wrist?

A
  • Finger extension test
  • Scaphoid shift test (Watsons)
  • Palpation SL interval
  • Linscheid test for 2nd and 3rd CMC
36
Q

What are special for wrist? Dorsal Ulnar

A
  • Piano key sign
  • DRUJ test
  • TFCC load test
  • TFCC stress test
  • Relocation test
  • LT Ballottment tesst
  • LT shear test
  • Ulnar impaction test
  • Ulnar snuff box palpation
  • ECU test
37
Q

Describe the TFCC shear stress test? + TFCC compression

A
  • Stabilise ulna and glide piso-triquetral compex dorsally
  • +ve test with symptom reproduction

TFCC compression:
- Other hand compresses TFC with axial pressure and glides P-T complex

38
Q

What are special tests for Volar Radial aspect?

A
  • Tinels
  • Phalens
  • Allens
39
Q

What are special test for Volar Ulnar aspect?

A
  • Pisiform palpation
  • hook of hamate palpation
  • Pisotriquetral shear test

PHTY APPB (10 decks)

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