MSK - Wrist & Hand Flashcards by Megan Gooder

What are the active movements of the wrist, normal ranges of motion and end feels?

Forearm pronation and supination 80-90° and 90° - tissue stretch
Flexion 80-90° - tissue stretch
Extension 70-90° - tissue stretch
Radial Deviation 15° - bone to bone
Ulnar Deviation 30-45° - bone to bone

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MMT - Flexor Carpi Radialis

Median Nerve C6-8
Sitting or supine, less than full supination, UD
Resistance applied into extension towards ulnar side

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MMT - Flexor Carpi Ulnaris

Ulnar Nerve C7-T1
Sitting or supine, full supination, RD
Resistance into extension toward radial side

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MMT - Extensor Carpi Radialis Longus (and Brevis)

Radial Nerve C5-8
Sitting, slight elbow flex, almost full pronation, wrist ext, RD
Resistance against dorsum of hand into flexion and UD

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MMT - Extensor Carpi Radialis Brevis

Radial Nerve C5-8
Sitting, less than full pronation, elbow flex to 90, 90 shoulder abd on table, RD
Resistance into wrist flex and UD

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MMT - Extensor Carpi Ulnaris

Radial Nerve C5-8
Sitting, full pronation, wrist ext, UD
Resistance against dorsum of hand on 5th MC into flex and RD

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What are the active movements, normal ranges, end feels in the hand?

Finger flexion (MCP 85-90°, PIP 100-115°, DIP 80-90°) - tissue stretch
Finger extension (MCP 35-40°, PIP 0°, DIP 20°) - tissue stretch
Finger abduction 20-30° - tissue stretch
Finger adduction 0°
Thumb flexion (CMC 45-50°, MCP 50-55°, IP 85-90°) - tissue stretch
Thumb extension (MCP 0°, IP 0-5°) - tissue stretch
Thumb abduction 60-70° - tissue stretch
Thumb adduction 30° - STA
Thumb opposition pulp to pulp - tissue stretch

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What is included in a functional hand scan?

Making a standard fist
Making hook grasp
Making a straight fist
Pulp to pulp - thumb to all fingers
Tip to tip pinch

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MMT - Flexor Pollicis Brevis

Deep: ulnar nerve C8-T1
Superficial: median C6-T1
Sitting, stabilizing hand. Apply resistance to palmar side of prox phalanx into extension direction

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MMT - Flexor Pollicis Longus

Median C6-T1
Sitting, stabilizing MCP and proximal phalanx
Resistance applied against palmar surface of distal phalanx

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MMT - Adductor Pollicis

Ulnar C8-T1

Sitting, resistance applied against medial side of thumb in abduction direction

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MMT - Extensor Pollicis Brevis

Radial C6-C8

Sitting, resistance against dorsal surface of proximal phalanx of thumb in flexion direction

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MMT - Extensor Pollicis Longus

Radial C6-C8

Sitting, resistance against dorsal surface of distal phalanx of thumb into flexion

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MMT - Abductor Pollicis Brevis

Radial C6-T1

Sitting, resistance against lateral surface of 1st MC into adduction

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MMT - Abductor Pollicis Longus

Median C6-C8

Sitting, resistance against lateral surface of distal end of 1st MC into adduction

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MMT - Dorsal Interossei

Ulnar C8-T1

Sitting, resistance against index and middle in ulnar direction. Middle and ring in radial direction

MMT - Palmar Interossei

Ulnar C8-T1

Sitting, resistance against thumb and index finger in radial direction. Ring and little finger in ulnar direction

MMT - Palmaris Longus

Median C6-T1

Sitting, forearms on table, cup palm. Resistance against thenar and hypothenar to flatten palm.

MMT - Flexor Digitorum Superficialis

Median C7-T1

Sitting, stabilize MCP of digit being tested. Resistance against palmar PIP into extension

MMT - Flexor Digitorum Profundus

Median and Ulnar

Sitting, slight wrist ext, stabilize PIP. Resistance against palmar DIP into extension

Tinel’s Sign

Tap over carpal tunnel.
+ve = tingling into median nerve distribution
Indicates: carpal tunnel

Phalen’s Test

Flex pt’s wrist maximally and push them together for 1 min.
+ve = tingling into median nerve distribution
Indicates: carpal tunnel

Reverse Phalen’s Test

Bring hands together and down by waist, into wrist ext. Hold for 1 min
+ve = tingling into median distribution
Indicates: carpal tunnel

Carpal Compression Test

Hold supinated wrist and apply direct, even pressure over median nerve for up to 30s.
+ve = tingling in median distribution
Indicates: carpal tunnel

Carpal Tunnel Relief Maneuver

Hand palm up, gently squeeze distal MC heads with slight adduction of digits 2-5. If basic maneuver not enough can pronate forearm and stretch digit 3 and 4. +ve = relief of symptoms Indicates: carpal tunnel

1st CMC Grind Test

Grasp thumb below MCP joint, apply axial compression and rotation to the 1st MCP joint

Lunotriquetral Shear Test

Grip pt wrist so thumb rests in pt palm and fingers are placed over dorsum of prox row of carpals to support lunate, Load pisotriquetral joint on palmar aspect with thumb, applying force to lunotriquetral joint. +ve = pain, crepitus, abnormal instability

Thumb UCL Laxity Test

Hold thumb in extension and apply valgus stress to MCP joint, also perform at 30 flexion +ve = laxity greater than other side, >30-35° indicates complete rupture

Ligamentous Instability of the Fingers Test

Stabilize finger with one hand and with other hand grasp distal to joint being tested. Apply varus or valgus stress to joint (PIP or DIP). +ve = laxity greater than other side Indicates: integrity of collateral ligaments

Finkelstein Test

Make fist with thumb inside fingers. Stabilize forearm and UD the wrist. Compare bilaterally. +ve = pain over APB and EPL, production of sharp pain with active extension/abduction of thumb and palpation over first dorsal component Indicates: paratendonitis of 2 tendons

Froment's Sign

Grasp piece of paper between thumb and index finger. Attempt to pull paper away. +ve = terminal phalanx of thumb flexes and can pull paper away. Indicates: paralysis of adductor pollicis (ulnar nerve paralysis)

Allen Test

Open and close hand several times quickly and then squeeze tightly. Place 1 thumb over both radial and ulnar arteries to compress them. Pt opens hand while pressure maintained. One artery tested by releasing pressure and seeing if hand flushes. Indicates: patency of radial and ulnar arteries