Sample Q&A Elbow, hand, wrist Flashcards
allen’s test
tests the patency of the radial and ulnar arteries
positive allen’s test
delay in refill of the hand (greater than 5 seconds)
indication of allen’s test
loss of patency of the artery being tested
possible causes of allen’s
subluxation, raynaud’s, old fracture, scar tissue, TOS
positive finklestein’s
- unable to bring thumb across and/or muscle wasting
2. pain along the radila side of the forearm
indications for finklestein’s
- ulnar nerve palsy
2. stenosing tenosynovitis of DeQuervain
differential diagnoses for finklestein’s
scaphoid fracture, carpal subluxation
treatment for positive Finkelstien’s
ice, biomechanical correction
what tendons make up tunnel of dequervain?
extensor pollicis brevis
abductor pollicis longus
what are some causes of ulnar nerve palsy?
trauma to the ulnar nerve, elbow subluxation
froment’s positive
patient’s thumb flexes in order to hand onto the paper
indication for positive froment’s
ulnar nerve palsy.
by flexing the thumb the patient recruits the median nerve in order to hand to the paper
most important thing to do for froment’s during a practical?
doctor should make sure that they could visualize the patient’s thumb. they must be able to see if the patient flexes the thumb
what ways are there to verify a positive froment’s
look for thenar or hypo-thenar muscle wasting; loss of strength in muscle tests, or utilize EMG
english test
remember to occlude the arteries before pumping the hand (hold for 6- seconds)
positive english
upon removing the arterial occlusion the symptoms of CTS are reproduced
indication for positive english
carpal tunnel syndrome
two reasons english test works
hypoxia, pooling of blood around the carpal tunnel increases presure on the median nerve
when will you most often see a positive reaction in english test?
when you release the blood supply after it has already pooled (at the end)
phalen’s test
hold position for up to a minut (if symptoms occur before one minute, stop test)
positive phalen’s
reproduction of the symptoms of CTS
indication for positive phalen’s
carpal tunnel syndrome
tinel tap test
perform for 10 seconds
positive tinel tap
reproduction of the symptoms of CTS
indication for tinel tap
capral tunnel syndrome
differential diagnoses for CTS
cervical subluxation pronator nerest syndrome elbow sulbuxation shoulder subluxation TOS raynaud's tenosynovitis of dequervain ulnar nerve palsy radila nerve palsy fractures trigger points on the thumb for stomach and liver
carpal tunnel syndrome symptoms
pain
paresthesia
numbness and tinglig in median nerve distribution
what is the length of time for performing the english test
hold up for a minute or if CTS symptoms appear before the minute is up
name two tests to verify a psotivie tinel tap
tests that could verify are phalen’s and english
what is the direction of carpal misalignment in CTS?
anterior lunate
is the lunate usually hypermobile or hypomobile in CTS?
lunate is usually hypermobile
what makes up the carpal tunnel
lunate at the posterior aspect and the transverse carpal ligament at the anteiror aspect
what are the contents of the carpal tunnel
9 flexor tenodns and the median nerve
the adjusting move of choice for CTS
wrist traction, FLEXION ONLY
best CTS post check
repeat the orthopedic tests that were positve on the pre-check
which CTS test would you not do as a post check and why?
don’t do reverse phalen’s, it would drive lunate anterior
what would you do after treating CTS?
after adjustment, brace or support the wrist then strengthening exercises
What procedure should the doctor perform to help differentially diagnose with a positive cozen or mill’s test?
palpate for tenderness
palpate to differntiate whether the pain is over the radial head or lateral epidondyle
what treamtent protocol would you perform for a lateral epicondylitis?
correct any biomechanical dysfunction, protect, ice the swelling, wear counter force armband, and change activities for the elbow as this alters the fulcrum for extension so ti’s not directly over the alteral epicondyle
postive cozen’s
pain over the lateral epicondyle
indication for positive cozen’s
lateral epicondylitis
positive mill’s
pain over lateral epicondyle
indication for positve mill’s
lateral epicondylitis
if lift test is postive what wouldthe doctor utuilze to help differentially diangose the cause of the finding?
positive- pain over epicondyle
indication- epicondylitis
postive lift test in pronation?
pain over lateral epicondyle
indication for positive lift test in pronation
lateral epicondyliits
if lift test was done in pronation, what else should you look for?
possible radius P with pain over radial head and decreased radila fluid motion
positive lift test in supination
pain over medial epicondyle
indication for postive lift test in supination
medial epicondylitis
if lift test was done in supination, what should you look for?
ulna P with pain 1-1.5 inches distal to the medial epicondyle, and decreased fluid motion
look for possible ulna PM with pain over the olecranon fossa area, and decreased fluid mmotion
positive adson’s
decrease in radial pulse amplitue (or absence of radial pulse)
indication for postive adson’s
scalenus anticus syndrome pressure on the subclavian artery and brachial plexus between the scalenus anticus scalenus medius 1st rib
how long do you palpate the radial artery when performing Adon’s
from 10-20 seconds, enough to decide if the pulse volume has changed
scalenus anticus syndrome is usually caused by?
subluxation
What do you do for a patient with scalenus anticus syndrome?
adjust the subluxation, use moist heat to relax muscles and stretch
what diangosis si suspected with a psitive adson’t when the head is turned away from the side being palpated?
may be scalenus medius syndrome or a cervical rib
is a cerivcal rib that causes loss of patency acute or chonic
usually acute exacerbation, because bone will normally modify away from the artery
positive eden’s
decrease inradial pulse amplitude (or absence of radila pulse
indication for postive eden’s
costoclavicular syndrome (TOS)
how to treat for a postive eden’s test?
determine if it is due to muscle guarding often a hypertonic pectoralis major, which needs to be stretched out
could also be a cervical, thoracic or rib that is subluxated
what questions might you ask a patient that has eden’s test postivie?
do they carry a backpack or heavy objects in front of them at work?
have they ever had an accident with the seatbelt on, fractured or dislocated their clavicle, or had shoulder problems?
positive wright’s
decrease in radial pulse amplitude (or absence of radial pulse)
indication of postive wright’s
hyperabduction syndrome (TOS)
what constitutes a positive wright’s test?
a 10-15 degree difference in left vs right arm abduction
you’re coparing where you lose the palpabe radial pulse from one arm to another
what is the most common muscle involed witha positive wright’s?
pec minor
what causes the pec minor to be shortened ro go into contracture?
cervical subluxation, subacromial bursitis, rolled posture, other types of TOS
which 3 subluxations would elbow traction work well for?
ulna P
ulna PM
radius P
what subluxation would elbow traction be most effective for?
ulna P
how would you post check elbow traction?
check the fluid motion that was lost in the pre-check; look for diminished pain point, and improved elbow extension ROM
when adjusting elbow subluxations when would you supinate and when would you pronate?
you would pronate for radius P and supinate for ulna P and ulna PM
What is the CP for radius P?
tip of thumb
what ROM are utilized during the radius P procedure?
full extension and full pronation
what is the pain point for radius P
right over the head of the radius
what are some differential diagnoses for radius P?
lateral epicondylitis, cervical subluxation (C5-6 area)
what ROM is decreased with radius P?
pronation
what subluxation might mimic the symptoms of lateral epicondylitis?
radius P
what is the pain point for ulna P?
1-1 1/2 inches distal to the medial epicondyle
what ROM are utilized during the ulna PM procedure?
supination and extension
what is the pain point for ulna PM?
olecranon fossa area
what is the major LOD for ulna PM?
P-A even though the DC and SCP are on the medial side of the arm
what ROM is deceased with ulna P and PM?
extension
what is the most common direction for the carpals to misalign?
posterior
what is the best post check for wrist traction?
fluid motion between carpals that were adjusted
where is the pain point for wrist traction?
right over the carpal that is misaligned
what are you stabilization hand fingers stabilizing the capitate STH?
proximal row of carpals
what ROMdo you tak the patient’s hand through while performing scaphoid DTH?
extension and radila deviation
what carpals do you test the scaphoid against for fluid motion?
trapezium, trapezoid, lunate
what are som differential diagnoses for a trapezium-scaphoid subluxation?
scaphoid fracture, DJD, stenosing tenosynovitis of dequervain, subluxation of scapho-lunate, trapezium 1st metacarpal
how would you differentiate the diagnostic possiblilities for a trapezium-scaphoid subluxation?
for the subluxation, you’d perform fluid motion, check pain points, utilize information from the case history, and xray.
for DJD, check xray and perform lab tests to differentiate the type of arthritis.
for stenosing tenosynovitis of dequervain perform finklestein’s.
for a scaphoid fracture xray, wait 10 days then xray again
is ther a difference between DJD and arthritis?
arthritis has inflammation, therefore you’d want to deal with any swelling befor adjusting to improve motion
what differnetila diagnoses should be ruled out before adjusting a scaphoid?
check for scaphoid fracture, radial styloid fracture, stenosing tenosynovitis of dequervain, other carpal subluxations, etc
name the wrist adjusting procedures from lead to most invasive
wrist traction, STH, DTH
the lunate usually misaligns in which direction?
posterior
in CTS the lunate usually misaligns in which direction?
anterior
which arpal is most common wrist subluxation?
lunate
what carpal is the 2nd most common wrist subluxation?
capitate
wich carpal is the 3rd most common wrist subluxation?
scaphoid
is the posterior lunate misalignemtn hypermobil or hypo mobile?
hypomobile
describe wrist traction maneuver CTS
traction S-I, flex
return to neutral
describe wrist traction maneuver for subluxation of a capal
traction S-I, flex, extend, return to neutral, release
what would be the move of choice when fluid motion is lost between scaphoid and lunate?
traction (transverse/horizontal) would be the move of choice, then STH, then DTH)
describe the scaphoid STH procedure
traction, extend and radially deviate
when is it very important to be sure of when perfomring the scaphoid DTH?
that all fingers are stabilizing the carapls aorund the scaphoid
what stabilizes the radius duing the scaphoid DTH?
patient’s own body weight
how would you perform wrist raction iwth a hypermibile anterior lunate?
traction S-I, flexion, return to neutral (DO NOT EXTEND)
where is the pain point for CMC joints
right over the joint
what direction does the 2nd CMC sulbuxated?
rotationally
how can a first metacarpal subluxation be identified?
look for loss of fluid motion, joint tenderness at the CMC joint, and a case history of jammed thumb, etc
which ROM is the most prevalent at the metacarpal-carpal joints?
rotation (hand cupping), not much in extension or flexion
what are some differntila diagnoses for a CMC 1st subluxation?
scaphoid subluxation, scpahoid fracture, trapezium fracture, stenosing tenosynovitis of dequervain, median nerve disturbance
what is the best way to post check the 2nd CMC
fluid motion
which one f the CMC 2-5 would be the most mobile?
5th CMC
how would you determine a CMC2-5 subluxation?
stabilize the distal row of carpals and rotate each metacarpal (relative to it’s adjacent carpal) to see if they have fludi motion. pain over CMC joint.
a case history with possibly a blow to the area, use of power tools, area was stepped on, a cast was recently removed, etc
what are normal ROMs for MCP and IP joints of the hand?
they should have glide from P-A and A-P as well as rotation
what type of joint pathologies would you perform MCP and IP traction for?
you would adjust the MCP and IP joints with traction for subluxation, jammed fingers, arthritic fingers, DJD, etc
what types of joint pathologies are MCP and IP traction good for?
any joint fixation, subluxation or dislocation, jammed finger, arthridities, DJD
