practical 1

Question 1

Distraction of Radiocarpal Joint

Answer 1

i. restriction -> general hypo mobility
ii. Open-Packed Position→ 10 degrees wrist flexion and slight ulnar deviation
iii. i. Patient position: sitting beside the treatment table with forearm pronated
ii. Examiner: get extra skin, one hand holds the distal radius and ulna as close to the joint space (wrist) as possible and the other grasps the proximal row of carpal bones
iii. Movement: distracting force to the proximal row of carpal bones (pull hand away from arm)

Question 2

Ventral Glide of Radiocarpal Joint

Answer 2

i. Restriction→ Wrist extension
ii. Patient position: sitting beside the treatment table with forearm pronated
iii. Examiner: one hand holds the distal radius and ulna as close to the joint space (wrist) as possible and the other grasps the proximal row of carpal bones
iv. Movement: ventral force to the proximal row of carpal bones (push down on hand and stabilize with other hand)

Question 3

Dorsal Glide of Radiocarpal Joint

Answer 3

i. Restriction→ Wrist Flexion
ii. Patient position: sitting beside the treatment table with forearm supinated
iii. Examiner: one hand holds the distal radius and ulna as close to the joint space (wrist) as possible and the other grasps the proximal row of carpal bones
iv. Movement: dorsal force to the proximal row of carpals (push down towards floor)

Question 4

Radial Glide of Radiocarpal Joint

Answer 4

i. Restriction→wrist ulnar deviation
ii. Patient position: sitting beside the treatment table with forearm in the midposition
iii. Examiner: one hand holds the distal radius and ulna as close to the joint space (wrist) as possible and the other grasps the proximal row of carpal bones (forearm on ulna side)
iv. Movement: radial force to the proximal row of carpal bones (pull up)

Question 5

Ulnar Glide of Radiocarpal Joint

Answer 5

i. Restriction: wrist radial deviation
ii. Patient position: sitting beside the treatment table with forearm supinated
iii. Examiner: one hand holds the distal radius and ulna as close to the joint space (wrist) as possible and the other grasps the proximal row of carpal bones
iv. Movement: ulnar force to the proximal row of carpal bones (push down)

Question 6

Carpometacarpal Joints Distraction: 2-5 Joints

Answer 6

i. Restriction→ general hypomobility
ii. Open-Packed Position→ resting
iii. Patient Position: sitting beside table with the forearm pronated
iv. Examiner: one hand is providing stabilization by holding the specific carpal bone with the index finger and the thumb and the other hand grips the corresponding metacarpal as close to the base as possible
v. Movement: distraction force to the proximal metacarpal (push towards arm)i. Restriction→ general hypomobility
ii. Open-Packed Position→ resting
iii. Patient Position: sitting beside table with the forearm pronated
iv. Examiner: one hand is providing stabilization by holding the specific carpal bone with the index finger and the thumb and the other hand grips the corresponding metacarpal as close to the base as possible
v. Movement: distraction force to the proximal metacarpal (push towards arm)

Question 7

Carpometacarpal Joints Ventral Glide: 2-5 joints

Answer 7

i. Restriction→ general hypomobility
ii. Patient position: sitting beside the table with the forearm pronated
iii. Examiner: one hand rests on the dorsum of the stabilized metacarpal and the other hand’s thenar eminence is placed on the metacarpal
iv. Movement: ventral force to the metacarpal being mobilized (push carpal down and stabilize metacarpal)

Question 8

Distraction: thumb

Answer 8

i. Restriction→ general hypomobility
ii. Open-Packed Position→ midway between flexion and extension and between abduction and adduction
iii. Patient Position: sitting beside the table with the forearm in midpostion
iv. Examiner: one hand stabilizes the trapexium and trapezoid with the thumb and index finger and the other hand is placed on the dorsal (thumb) and palmar (index) surface of the patient’s first metacarpal
1. Stabilize CMC and grab thumb at metacarpal
i. Movement: distraction force to the patient’s first metacarpal (pull away)

Question 9

Ulnar Glide: Thumb

Answer 9

i. Restriction→ flexion of the thumb
ii. Patient Position: sitting beside a table with the forearm in midposition (halfway between pronation and supination)
iii. Examiner: one hand is stabilizing the trapezium and trapezoid with the thumb and index finger and the other hand’s thenar eminence is on the 1st metacarpal of the patient’s thumb and the fingers are wrapped around the thumb to assist in maintaining a resting position
iv. Movement: ulnar directed force through the thenar eminence to the radial aspect of the patient’s metacarpal (push down)

Question 10

Radial Glide: Thumb

Answer 10

i. Restriction→ extension of the thumb
ii. Patient Position: sitting beside a table with the forearm in midposotion
iii. Examiner: one hand is stabilizing the trapezium and trapezoid with the thumb and index finger and the other hand’s thenar eminence is on the 1st metacarpal of the patient’s thumb and the fingers are wrapped around the thumb to assist in maintinging a resting position
iv. Movement: radial directed force through the thenar eminence to the ulnar aspect of the patient’s 1stmetacarpal

Question 11

Dorsal Glide: Thumb

Answer 11

i. Restriction→ Abduction of the thumb
ii. Patient Position: sitting beside a table with the forearm supinated
iii. Examiner: one hand is stabilizing the trapezium and trapezoid with the thumb and index finger and the other hand’s thenar eminence is on the 1st metacarpal of the patient’s thumb and the fingers are wrapped around the thumb to assist in maintaining a resting position
iv. Movement: dorsally directed force through the thenar eminence to the anterior aspect of the patient’s 1st metacarpal (pull up on metacarpal)

Question 12

Ventral Glide: Thumb

Answer 12

i. Restriction→ Adduction of the thumb
ii. Patient Position: sitting beside a table with the forearm supinated
iii. Examiner: one hand is stabilizing the trapezium and trapezoid with the thumb and index finger and the other hand’s thenar eminence is on the 1st metacarpal of the patient’s thumb and the fingers are wrapped around the thumb to assist in maintaining a resting position
iv. Movement: Ventrally directed force to the posterior aspect of the patient’s 1st metacarpal

Question 13

Metacarpophalangeal and Interphalangeal Joints

Answer 13

Distraction, ventral and dorsal glide:

i. Restriction→ General hypomobility, flexion and extension
ii. Open-Packed Position→ slight flexion
iii. Patient Position: sitting with the proximal articulating partner stabilized on the wedge
iv. Examiner: one hand is placed on the dorsal surface of the stabilized bone to provide additional support and the thumb and index finger of the other hand are placed on the dorsal and palmar surfaces of the subject’s distal articulating partner as close to the joint space as possible
v. Movement: distraction force to the distal articulating segment for generalized hypomobility restriction (pull towards clinician)

Question 14

Trapezium

Answer 14

base of first metacarpal

Question 15

Scaphoid

Answer 15

near thumb

Question 16

Trapezoid

Answer 16

base of index finger

Question 17

Capitate

Answer 17

base of 3rd metacarpal =

Question 18

Lunate

Answer 18

right under capitate; valley of listers tubercle and flex wrist

Question 19

Hamate

Answer 19

volar side under pink

Question 20

Pisiform

Answer 20

follow flexor carpi ulnaris tendon, bump on palmar/pinky side of hand

Question 21

Triquetrum

Answer 21

right under pisiform, ulnar side`

Question 22

SPIN

Answer 22

specificity, RULE IN, positive tests, rule in

Question 23

SNOUT

Answer 23

Sensitivity, RULE OUT, negative tests, rule out