Hand & Wrist Flashcards
WRIST AROM
Flex: 80-90o
Extend: 70-90o
UD: 30-45o
RD: 15o
FINGER AROM
MCP
Flex: 85-90o
Extend: 30-45o
Abd: 20-30o
Add: 0o
PIP
Flex: 100-115o
Extend: 0o
DIP
Flex: 80-90o
Extend: 20o
Thumb AROM
CMC
Flex: 50-55o
Extend: 0o
Abd: 60-70o
Add: 30o
Opp: -
MCP
Flex: 50-55o
Extend: 0o
IP
Flex: 85-90o
Extend: 0-5o
N End Feel
Tissue Stretch
Pronation, supination, Wrist Flex/Ext
Finger Flex/Ext/AB
Thumb Flex/Ext/AB
Opposition
Bone-Bone
UD, RD
Tissue Approximation
Thumb Adduction
RC, CMC, MCP, IP –> R, C, CP
RC (wrist)
R: Neutral w UD
C: Extend w RD
CP: Flex & Extend
CMC
R: Thumb bw abd & add, flex & ext - Fingers bw flex & extend
C: Thumb full opposition, Fingers Full Flexion
CP: Thumb, abduction, extension - Fingers, equal limitation in all directions
MCP
R: Slight flexion
C: Thumb in full opposition - Fingers in full flexion
CP: Flexion, extension
IP
R: Slight flexion
C: Full extension
CP: Flexion, extension
Functional Testing of the Hand
Get them to make a fist, hook grasp, straight fist, and pincer grasp with each finger (palm and point)
TESTING: Fine motor control
Independence in Activities of Daily Living (ADL) functionally requires:
* Wrist Flexion: 10°
* Wrist Extension: 35°
* Radial Deviation: 10°
* Ulnar Deviation: 15°
Varus Stress Test
Hands in anatomical position.
Perform on the pips and dips: support the joint below and actually grab the joint and apply varus force.
TESTING: LCL
+ve: pain or laxity in LCL
Valgus Stress Test
Hands in anatomical position.
Perform on the pips and dips: support the joint below and actually grab the joint and apply valgus force
TESTING: Medial collateral ligament (MCL)
+ve: pain or laxity in MCL
Murphy’s Sign
Instruct the patient to make a fist and elevate off the table. Observe the position of the third metacarpal. If it is aligned with (rather than projecting beyond) the second and fourth metacarpals, the test is positive.
TESTING: Lunate Dislocation
+ve: The head of the third metacarpal is level with the 2nd and 4th metacarpals, indicating possible lunate dislocation
Finkelstein Test
The patient makes a fist with the thumb tucked inside the fingers. The examiner stabilizes the forearm and ulnarly deviates the wrist.
TESTING: De Quervain Disease OR More common thumb paratendonitis.
+ve: Pain over the abductor pollicis longus and extensor pollicis brevis tendons at the wrist
Phalen’s Test
The examiner maximally flexes the patient’s wrists and holds this position for 1 minute. The examiner makes them hold this position (keep hands together) by pushing down on the patients elbows.
TESTING: Carpal tunnel syndrome
+ve: Tingling in the thumb, index finger, middle finger, and lateral half of the ring finger
Tinel’s Sign
Examiner taps over carpal tunnel w 2 fingers
TESTING: Carpal tunnel syndrome
+ve: Tingling in median nerve distal to where you are tapping
Allen Test
Ask the patient to open and close the hand quickly a few times, then squeeze tightly. Compress both radial and ulnar arteries. Have the patient open the hand and release pressure on one artery. Observe how long it takes for color to return. Compare both hands.
TESTING: Poor blood flow and potential artery obstruction or compromise.
+ve: Delayed flushing (over 6 seconds)
Radial Flush: 2.5–3.5 seconds
Ulnar Flush: 2–3 seconds
Ulnomeniscotriquetral Dorsal Glide
The patient sits with the arm pronated. The examiner stabilizes the ulna with the thumb on the ulnar head and the index finger over the pisotriquetral (pisiform and triquetrum) complex anteriorly. The examiners other hand is over the PIP joints of the clients hand. The examiner then applies a posteriorly directed force through the pisotriquetral complex stressing the TFCC w index finger.
TESTING: Sprain in TFCC
Excessive laxity or pain
Watson (Scaphoid Shift) Test
The patient sits with the elbow resting on the table and forearm pronated. The examiner takes the patient’s wrist into full ulnar deviation and slight extension while holding the metacarpals with one hand. The thumb of the other hand is placed on the scaphoid tubercle to prevent its movement. The examiner then radially deviates and slightly flexes the hand, maintaining pressure on the scaphoid tubercle, creating a subluxation stress.
TESTING: Subluxation of Scaphoid and lunate
+ve: Pain during radial deviation or a “thunk” sensation with scaphoid subluxation.
Pain and thunk = fracture
