Ortho 2 (special tests/glides): Wrist/Hand Flashcards
wrist - ROM (flex, ext, RD, UD, forearm pron/sup)
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wrist - RISOM (flex, ext, RD, UD, forearm pron/sup)
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finger MCP ROM (flex, ext, abd, add)
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finger MCP RISOM (flex, ext, abd, add)
Finger DIP/PIP ROM (flex,ext)
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Finger DIP/PIP RISOM (flex,ext)
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Thumb ROM (CMC: flex, ext, abd, add, MCP: flex, ext, IP: flex, ext)
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Thumb RISOM (CMC: flex, ext, abd, add, MCP: flex, ext, IP: flex, ext)
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wrist palpation - bony structures
wrist - distal RU joint (palmar and dorsa glide)
**looking for: neutral zone, R1, R2, any pain
Pt: Seated or supine & F/A in resting position
Pht:
- Standing, facing pt’s hand
- One hand: stabilizes ulna
- One hand: grasp pt’s distal radius
wrist - RC joint (palmar and dorsal glide)
**looking for: neutral zone, R1, R2, any pain
Pt: Seated, F/A resting on bed; wrist over edge & in RP
Pht:
- Standing, close to pt’ hand
- One hand: stabilize distal radius/ulna close to jt line
- One hand: grasp proximal row of carpals
wrist (RC joint) - radial and ulnar glide
**looking for: neutral zone, R1, R2, any pain
wrist (RU joint) traction and compression
**looking for: neutral zone, R1, R2, any pain
fingers - MCP joint (palmar, dorsal, medial, lateral glides)
Pt seated, FA on bed & joint in RP (slight flexion)
Pht: using a pinch grip with both hands
- For palmar & dorsal glides: on palmar/dorsal aspect of bones
- For radial & ulnar glides on radial/ulnar aspect of bones
- One hand: stabilize distal MC (♂), close to jt line
- One hand: grasp proximal phalanx (♀)
fingers - MCP joint (traction/compression)
Pt seated, FA on bed & joint in RP (slight flexion)
Pht: using a pinch grip with both hands
- For palmar & dorsal glides: on palmar/dorsal aspect of bones
- For radial & ulnar glides on radial/ulnar aspect of bones
- One hand: stabilize distal MC (♂), close to jt line
- One hand: grasp proximal phalanx (♀)
fingers - IP joint (palmar and dorsal glide)
Pt seated, with FA on bed & joint in resting position (slight flexion)
Pht: using a pinch grip with both hands
- One hand: stabilize proximal phalanx (♂), close to jt line
- One hand: grasp base of adjacent (distal) phalanx (♀)
fingers - IP joint (traction/compression)
Pt seated, with FA on bed & joint in resting position (slight flexion)
Pht: using a pinch grip with both hands
- One hand: stabilize proximal phalanx (♂), close to jt line
- One hand: grasp base of adjacent (distal) phalanx (♀)
wrist - distal ru ligament stress test
Findings:
Gr I sprain: Strong normal EF & pain
Gr II sprain: Solid Firm EF but much further into range & P
Gr III sprain: Sluggish or NO EF with more or less pain
Position:
- Pt seated
- Pht facing pt, look for NZ, EF & pain; hold 5sec
wrist - RCL and LCL ligament stress test
Wrist collateral ligaments
Pt: wrist in extension (just out of CPP)
Pht:
- One hand: stabilize distal radius/ulna
- One hand: grasps proximal & distal rows of carpal bones
Findings:
Gr I sprain: Strong normal EF & pain
Gr II sprain: Solid Firm EF but much further into range & P
Gr III sprain: Sluggish or NO EF with more or less pain
Position:
- Pt seated
- Pht facing pt, look for NZ, EF & pain; hold 5sec
wrist MCP collateral ligaments stress tests
Findings:
Gr I sprain: Strong normal EF & pain
Gr II sprain: Solid Firm EF but much further into range & P
Gr III sprain: Sluggish or NO EF with more or less pain
Position:
- Pt seated
- Pht facing pt, look for NZ, EF & pain; hold 5sec
finger DIP and PIP collateral ligament stress tests
Findings:
Gr I sprain: Strong normal EF & pain
Gr II sprain: Solid Firm EF but much further into range & P
Gr III sprain: Sluggish or NO EF with more or less pain
Position:
- Pt seated
- Pht facing pt, look for NZ, EF & pain; hold 5sec
wrist - finkelstein test
wrist - TFCC supination lift test
wrist - TFCC ulnar impaction test
wrist - TFCC load test
Wrist mobs of lateral column
The carpal bones should be mobilized in flexion.
Wrist mobs of medial column
mobs should be done in wrist flexion
Wrist mobs of mid column
mobs should be down with wrist in flexion
Thumb (CMC) traction/compression
Thumb (CMC) dorsal glide
Thumb (CMC) palmar glide
Thumb (CMC) radial glide
Thumb (CMC) ulnar glide
wrist manipulation - thrust in traction (lunate on radius)
Indications:
S/A: Mechanism of injury: full extension or flexion
O/A:
- Observation/palpation: any protuberance or dimple
- ROM: flexion or extension ↓ & hard EF & pain
- Glide: carpal bone palmar or dorsal glide ↓ NZ & hard EF
Special Considerations:
- Scaphoid fracture (< 2wks) – can have been missed on x-ray
- Carpal bones hypermobility
- Nerves & blood vessel compression
wrist manipulation - palmar glide (lunate on radius)
Indications:
S/A: Mechanism of injury: full extension or flexion
O/A:
- Observation/palpation: any protuberance or dimple
- ROM: flexion or extension ↓ & hard EF & pain
- Glide: carpal bone palmar or dorsal glide ↓ NZ & hard EF
Special Considerations:
- Scaphoid fracture (< 2wks) – can have been missed on x-ray
- Carpal bones hypermobility
- Nerves & blood vessel compression
wrist manipulation - dorsal glide (lunate on radius)
Indications:
S/A: Mechanism of injury: full extension or flexion
O/A:
- Observation/palpation: any protuberance or dimple
- ROM: flexion or extension ↓ & hard EF & pain
- Glide: carpal bone palmar or dorsal glide ↓ NZ & hard EF
Special Considerations:
- Scaphoid fracture (< 2wks) – can have been missed on x-ray
- Carpal bones hypermobility
- Nerves & blood vessel compression
