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Musculoskeletal 1 > Practical 2 - Elbow, wrist, hand, and foot > Flashcards

Practical 2 - Elbow, wrist, hand, and foot Flashcards

1
Q

General Distraction Technique of the elbow

A
  • Open Pack: 70-90 degrees of flexion
  • Supine
  • Stabilize humerus on table
  • Wrap hand around forearm
  • Try to mobilize the ulna
  • Angle distraction down a little bit
  • Can be turned into treatment with steady stretch or oscillations
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2
Q

Golpher’s Grip

A
  • When flex, radius moves proximally
  • When we extend, the radius moves distally
  • Distract the radius
  • Looking at annular ligament
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3
Q

Saw Miller’s Grip

A
  • Handshake grip
  • Approximate and put force through radius
  • Hand on wrist to give force
  • Proximal glide of radius with flexion
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4
Q

Radial Head anterior

A
  • Open Pack (70-90)
  • Forearm midpronation and Supination
  • Stabilize fingers under ulna and humerus
  • Move radius anterior (ventral)
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5
Q

Radial Head posterior mobs

A
  • Open Pack (70-90)
  • Forearm midpronation and Supination
  • Stabilize fingers under ulna and humerus
  • Move radius posterior
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6
Q

Distal Radioulnar Joint mobilization

A
  • Concave distal radius on convex ulna
  • Stabilize ulna and move radius in direction of motion
  • Can also use splay techniques (move your thumbs apart at the radioulnar joint)
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7
Q

Varus, valgus stability of the elbow

A
  • Collateral ligaments should give a little bit
  • Supine
  • Stabilize humerus on table
  • Elbow almost fully extended but can be flexed a little bit
  • With full extension you are testing the capsule and collaterals
  • With slight flexion you are testing the collaterals more
  • In a closed pack position (elbow straight) the olecranon process is going into the olecranon fossa (if this is lax, there could be a fracture)
  • Lateral epicondylitis – palpation, resisted isometric, maximal stretch of musculature
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8
Q

Mills Test

A
  • Mills Test
  • supination, wrist extension, extend elbow
  • Palpate over medial epicondyle
  • Looking for golfers elbow
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9
Q

Tinel’s sign – ulnar nerve

A
  • Posterior medial epicondyle through ulnar groove
  • Tunnel of Guyan (ulnar nerve passes between hammate and pisiform)
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10
Q

Pronator teres contraction – median nerve

A
  • Resist Pronation so pronator teres contracts and the median nerve is compressed since it goes between the heads
  • Can stretch pronators in Supination
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11
Q

Lateral epicondylitis Mills Test

A
  • Pronate, flex wrist and extend the elbow
  • Palpate over the common extensor tendon; if pain, positive for lateral epicondylitis (tennis elbow)
  • Palpation; tendonitis or tenosynovitis when flex elbow taking out extensor carpi radialis longus
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12
Q

Pinch grip test “OK” sign

A
  • patient is asked to pinch tips of index and thumb together
  • unable to do this = anterior interosseous nerve pathology
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13
Q

Pronator teres test

A
  • elbow flexed to 90
  • resist pronation
  • tingling in the median nerve distribution is a positive test for nerve entrapment
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14
Q
A
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15
Q

Finkelstein Test

A
  • determines presence of de quervian or Hoffmann disease, paratenonitis in the thumb
  • patient makes a fist with thumb inside fingers
  • examiner stabilizes forearm and ulnarly deviates wrist
  • positive test = pain on the APL
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16
Q

Brunnel - Littler Test

A
  • Extend MCP and then passive flex PIP (+ if unable to flex PIP)
  • If the MCP are held in flexion and PIP is able to fully flex = intrinsic tightness
  • If JUST the first position is tight it is due to intrinsic tightness,
  • if the first AND second position is tight it is due to capsular tightness
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17
Q

Tinels Sign: Median N

A
  • tap over the carpal tunnel at the wrist
  • positive means that there is numbness over the median distribution of the wrist
  • means they have Carpal tunnel syndrome
18
Q

Tinels sign: ulnar nerve

A
  • tunnel of Guyan
  • between the hamate and the pisiform
  • taping this area may cause numbness across the ulnar distribution
  • indicates ulnar nerve entrapment
19
Q

Phalen’s Test

A
  • carpal tunnel syndrome
  • examiner flexes the patients wrist maximally
  • can have the patient hold both wrists in this position for 1 minute
  • (+) test = tingling in median nerve distribution
20
Q

Reverse Phalen’s Test

A
  • also called prayer test
  • patient holds prayer pose for 1 minute
  • (+) test gives same symptoms seen in phalens test
  • indicates median nerve pathology
21
Q

Allen Test

A
  • tests for circulation and swelling
  • examiner occludes radial nd ulnar artery
  • patient is asked to open and close hands quickly until palm is white
  • one artery and can released to see if hand floss
22
Q

Hand Volume Test

A
  • volumetric to determine swelling of the hand
23
Q

Froment Sign

A
  • patient attempts to grasp a piece of paper between the thumb and index finger
  • when the examiner attempts to pull away the paper
  • if examiner is able to pull away the paper/the patient compensates with “OK” sign = (+)
  • indicates ulnar nerve paralysis
24
Q

Subtalar neutral (WB/NWB)

A
  1. Non-WB: have pt. prone with relaxed foot
    - Invert and evert foot palpating the talus
    - Once feel equal pressure of the talus on both fingers you are in subtaler joint neutral
  2. WB: same as above, but standing
    - Want to have patient pronate and supinate
    - Once relax you can see if navicular drops below feiss line signaling a pronated foot.
25
Q

Homan’s sign

A

DF and squeeze calf
- (+) test indicates a blood clot

26
Q

Anterior Drawer- ankle

A
  • supine
  • 10-15 degrees of plantarflexion.
  • Stabilize tibia and fibula, grab calcaneus and pull anteriorly
  • anterior ligaments: Anterior talofibular, tibiotalar, and tibionavicular
27
Q

Feiss line, navicular drop test

A
  • in standing find subtalor joint neural
  • tell patient to then relax
  • see how far the navicular drops
  • should be in alignment with the medial malleolus and the 1st MTP
28
Q

Rearfoot alignment

A
  • Want to find subtalar joint neutral and see if calcaneus is inverted or everted by comparing it to the midline of the calf
  • Normal is 0-4 degrees varus
29
Q

Forefoot alignment

A
  • find subtalar joint neural
  • Look down through calcaneus to see if 1st ray is up (varus) or 5th ray is up (valgus)
30
Q

Tinel’s sign at TT

A
  • tibial nerve behind medial malleolus.
  • Can do tinel’s sign for the deep peroneal nerve as well
  • Tap on the tibial nerve to look for irritation or pain
  • Tap on the deep peroneal nerve on the medial/dorsum of the foot
31
Q

Capillary refill

A
  • Squeeze Great Toe on nail and bottom of toe and watch how quickly the blood comes back through
  • If the patient is wearing nail polish squeeze the sides of the toe
32
Q

External Rotation Test(ankle)

A
  • high ankle sprain
  • flex knee to 90 degrees, support foot, then laterally rotate; positive test = pain in anterior distal tibia ,fibula
33
Q

Posterior drawer (ankle)

A
  • slightly supinate the ankle (locks up forefoot bones), glide posteriorly holding on top
  • Posterior ligaments: posterior tibiotalar , tibiocalcaneal, posterior Talofibular
34
Q

Valgus of ankle

A
  • Take ankle into dorsiflexion then do a valgus (in) force and palpate at the same time.
  • Should feel tissues get taut while palpating
35
Q

Varus instability test of the ankle

A
  • Take ankle into dorsiflexion then do a varus (out) force and palpate at the same time.
  • Should feel tissues get taut while palpating
36
Q

Squeeze test

A
  • high ankle sprain
  • mid point of tib and fib. squeeze tibia and fibula together, distally there is spreading; positive test = pain
37
Q

Cross leg test

A
  • high ankle sprain
  • sit with affected leg on top of other, have gravity pull foot into external rotation, while the leg weight compresses tibia and fibula. May cause pain (similar reasons to squeeze test)
38
Q

Thompson squeeze test

A
  • achilles heel rupture
  • pt in prone; squeeze gastroc; looking for PF of foot which is normal; positive test = no plantarflexion of foot.
  • Can be a false negative if FD is still intact
39
Q

Eccentric heel raises

A
  • tendinosis: hurts when rest
  • Tendonitis: hurt when moving around.
40
Q

Squeeze test

A
  • high ankle sprain
  • supine
  • squeeze midway up the tibia and fibula
  • positive = pain in the distal tib-fib joint

Musculoskeletal 1 (42 decks)

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