Practical section 5 Flashcards
Using Distal upper extremity (focus on the hand) to support performance in areas of
Occupation
Dynamometer
Standard and second position
Three trials on each hand (switch hands)
Arm at side, elbow flexed at 90 degrees, wrist in neutral
Take the average of the 3 scores from each hand
“squeeze the lever as hard as you can”
have them do it three times on right hand -> move knob to zeroe
have them do it on left hand- keep moving knob to zeroe after each try
Pinch Gauge
Three trials on each hand, take the average of the 3 scores from each hand
Arm at side, elbow flexed at 90 degrees, wrist in neutral
Tip to tip (two-point pinch)
Lateral pinch (key pinch)
Three-point pinch (3 jaw chuck)
Provocative tests
Phalens and Tinels (at volar wrist) and which diagnosis?
a.) Phalens (Carpal Tunnel Syndrome )
Forced flexion for 30-60 seconds
Positive is burning, tingling, or numb sensation
b.)
Provocative tests: Tinels
(CTS, lateral and medial epicondylitis)
Lightly tapping over the nerve to elicit a sensation of tingling or “pins and needles” in the distribution of the nerve (thumb, index and middle finger for CTS)
Froment’s and diagnoses
Ulnar nerve Palsy
Lateral pinch holding a piece of paper (you across from the patient) and pulling away from them
Positive is failure or popping up of the thumb showing compensation
Finkelsteins and diagnosis
DeQuarvains
Thumb is placed in the closed first and the hand is in ulnar deviation
Positive is pain along distal radius
Tenosynovitis of first dorsal compartment
Cozens Test
Cozens (lateral epicondylitis) active and resistive
Stabilize elbow and palpate lateral epicondyle. With a closed fist, pt supinates and extends the wrist against resistance (of you pushing them into flexion)
Positive is pain with motion and/or over the lateral epicondyle
Mill’s Test
Mills (lateral epicondylitis) passive
You stabilize the elbow
Stretch them into wrist flexion, stretching the wrist extensors
Remember to put the fingers into flexion
To provoke more, bring the elbow into extension
Positive: pain over the lateral epicondyle
Tendon glides
Opposition
Do this for each finger, making sure the pt makes the correct “O” position with the fingers
Blocking exercises
a.) MCP b.)PIP c.) DIP
Purdue Pegboard 30 second test
Measuring Fine Motor Coordination and bimanual skills bimanual skills
General instructions:
Patient sitting at table with PPT midline to patient
Demonstrate before each test (test uninvolved side first) and let them practice
Test 1: right hand placing pegs in right side (30 sec)
Start with their hand on the board
At the end of the time limit, count how many pegs they have in the board
Test 2: left hand placing pegs in left side (30 sec)
Start with their hand on the board
At the end of the time limit, count how many pegs they have in the board
Test 3: both hands at same time (30 sec)
Start with their hands on the board
At the end of the time limit, count how many pegs they have in the board
Test 4: Assembly: moving hands at same time: peg, washer, colander, washer (1 min)
Start with their hands on the board
At the end of the time limit, count how many pegs they have in the board, for the 4-part structure, each piece of the structure counts as a point, not the full structure itself
Start time when say begin, then stop at allotted time, then count how many completed
9-hole peg test
Measuring fine motor coordination (FMC)
General instructions:
Patient sitting at table with NHPT at midline and horizontal with well facing hand being tested (test uninvolved hand first) and make sure the cup is on the side of the hand that you are testing
Instruct patient to take pegs from well, one by one, and place into the holes as fast as they can, once full then remove
Start timer when first touch peg, stop timer once last peg touches well
If unable to complete, count how many pegs completed and take the time
