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Hygiene Theory IV > Test 2 > Flashcards

Test 2 Flashcards

1
Q

What is an RSI?

A

Repetitive strain injury

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2
Q

What is an MSD?

A

Musculoskeletal disorder

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3
Q

What are the common neck pain injuries for dental hygienists?

A

Cervical strain/sprain
Headaches

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4
Q

What are the common elbow pain injuries for dental hygienists?

A

Tennis/Golfe
Overuse/RSI

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5
Q

What are the common mid back pain injuries for dental hygienists?

A

Postural strain
Overuse

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6
Q

What are the common lower back pain injuries for dental hygienists?

A

Mechanical lower back pain
Disc bulge/herniation

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7
Q

What are the common wrist pain injuries for dental hygienists?

A

Carpel tunnel syndrome
De Quervain’s Tenosynovitis

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8
Q

What are the common shoulder pain injuries for dental hygienists?

A

Rotator cuff strain
Biceps tendonitis

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9
Q

What is the study of human performance and workplace design?

A

Ergonomics

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10
Q

Dental hygienists are at risk for repetitive strain injuries and muscoloskeletal disorders involving

A

Tendons
Tendon sheaths
Muscles
Nerves

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11
Q

True or False: detal hygienists hold postures that require more than half of the body’s muscles to contract and resist gravity.

A

True

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12
Q

What are the ergonomic environment factors?

A

Dental unit
Clinician’s chair
Gloves
Instruments

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13
Q

What are the benefits of a saddle chair?

A

Easier to maintain neurtal posture
Diaphrahmatic breathing is improved
Allows easy proximity to patient
Moving stool is easier
Forces correct movement at the hips instead of bending at the waist

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14
Q

What about gloves is a concern for ergnomics?

A

Can’t be too tight or too loose

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15
Q

What about instruments is a concern for ergonomics?

A

Dull leads to additional force, lateral pressure, strokes, and tightened grasp
Handle size for comfortable grasp
Mechanized instruments have higher risk for for vibratory RSIs

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16
Q

What positioning factors come into play with ergonomics?

A

Client position
Clinician position
Equipment position

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17
Q

How should patient positioning affect ergonomics?

A

It should allow for the hygienist to perform intraoral procedures without increasing the risk of RSIs

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18
Q

How should the clinician’s shoulder be positioned?

A

Level and held at their lowest, most relaxed position

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19
Q

How should the clinician’s elbow be held?

A

At a 90 degree angle close to the clinician’s body

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20
Q

How should the clinician’s forearms be held?

A

At the same plane as the wrist and hand

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21
Q

How should the clinician’s wrist be held?

A

Never bent, but held straight

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22
Q

How should the clinician’s torso be held?

A

Straight back
Straight neck
Erect head

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23
Q

How should the clinician’s lower body be held?

A

Feet flat on the floor
Knees slightly below the hips at 105 to 125 degree angle

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24
Q

How far forward is okay for the clinician to tilt the head or waist?

A

Less than 20 degrees

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25
Q

What are the five categories of motion?

A

Class I: using fingers only
Class II: using fingers and wrist
Class III: moving fingers, wrist, and arms
Class IV: moving entire arm and shoulder
Class V: moving arm and twisting body

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26
Q

What classes should dental clinician’s limit their movements to?

A

Classes I, II, and III.

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27
Q

Why is it important to manage your appointments?

A

Control of appointment procedures and time can reduce possible RSIs.

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28
Q

How should appointments be alternated?

A

New clients with recare clients
Root debridment and therapeutic scaling with maintenance appointments
Difficult with less difficult

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29
Q

Would shortening recare intervals be helpful to ergonomics?

A

Yes

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30
Q

Does stress affect work related MSDs?

A

Yes

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31
Q

What nonoccupational factors are risk factors for MSDs?

A

Increasing age
Female gender
Hereditary traits
Systemic illness

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32
Q

What improves strength and flexibilty, lumbar spine, neck mescule, lower back health, stretches and extends back muscles, strengthens abdominal muscles, and strengthens finer, hand, and arm muscles?

A

Strengthening exercises

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33
Q

What is carpal tunnel syndrome?

A

The median nerve becomes compressed within the carpal tunnel

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34
Q

What is the most common RSI reported by dental hygienists?

A

Carpral tunnel syndrome

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35
Q

How many hygienists report carpal tunnel syndrome symptoms?

A

About 1/3

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36
Q

What are the signs and symptoms of carpal tunnel syndrome?

A

Numbness in thumb/fingers
Pain in the hand, wrist, shoulder, neck, and lower back
Nocturnal pain in hands and forearms
Morning and/or daytime stiffness and numbness
Loss of strength in hands
Cold fingers
Increased fatigue in fingers, hand, wrist, forearm, and shoulders
Nerve dysfunction

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37
Q

What are the treatments for carpal tunnel syndrome?

A

Inflammatory medications
Vitamins
Corticosteroid injections
Iontophoresis
Wrist brace
Surgery cutting the transverse carpal ligament

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38
Q

What is the biggest risk factor for carpal tunnel syndrome?

A

Repetition

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39
Q

What are the other risk factors for carpal tunnel syndrome?

A

Holding instruments too tightly
Vibrating intrustments
Cold temperatures
Tight gloves

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40
Q

How to prevent carpal tunnel syndrome?

A

Maintain good posture
Neutral arm and wrist
Support your body with knees
Shoulders relaxed

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41
Q

What is the compression of the neurovascular bundle that results in decreased blood flow to the nerve functions of the arm?

A

Thoracic outlet compression

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42
Q

What are the symptoms of thoracic outlet compression?

A

Numbness
Tingling
Weakness
Clumsiness
Coldnes of arms and hands
Neck and shoulder spasms
Absence of radial pulse

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43
Q

What causes thoracic outlet compression?

A

Poor clinician’s position (tilting head too much and hunching shoulders) and client too high

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44
Q

What is the treatment for thoracic outlet compression?

A

Physical therapy

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45
Q

How to prevent thoracic outlet compression?

A

Maintain proper clinician and client position

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46
Q

What is ulnar nerve entrapment at the wrist?

A

Guyon’s canal syndrome

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47
Q

How is carpal tunnel different from guyon’s canal syndrome?

A

The ulnar nerve affected in guyon’s canal syndrome does not pass through the carpal tunnel

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48
Q

What are the symptoms of guyon’s canal syndrome?

A

Numbness and tingling in little finger and part of ring finger
Loss of strength
Clumsiness
Loss of small muscle movement

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49
Q

What are the treatments for guyon’s canal syndrome?

A

Wrist brace
Corticosteroid injections
Surgery cutting the roof of the guyon’s canal to relieve the nerve entrapment

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50
Q

How to prevent guyon’s canal syndrome?

A

Attention to the hand and finger placements, repositioning the little finger during scaling and periodic hand stretches

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51
Q

What is the inflammation of the tendons or tendon sheaths at the base of the thumb which result in thumb weakness that migrates to the forearm?

A

de quervain syndrome

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52
Q

What causes de quervain syndrome?

A

Repetitive motion of hand twisting combined with forceful grip, prolonged position of wrist in ulnar deviation

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53
Q

What are the symptoms of de quervain syndrome?

A

Aching and weakness of thumb
Pain migrating to forearm

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54
Q

What are the treatments for de quervain syndrome?

A

Rest
Anti-inflammatory medications
Immobilization of wrist
Corticosteroid injections
Progressive physical therapy
Surgery

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55
Q

How to prevent de quervain syndrome?

A

Neutral wrist position

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56
Q

What is a degenerative elbow disorder causing inflammation of the wrist extensor tendons also known as tennis elbow?

A

Lateral epicondylitis

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57
Q

What are the symptoms of lateral epicondylitis?

A

Aching/pain in elbow
Sharp shooting pain during elbow extension

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58
Q

What are the treatments for lateral epicondylitis?

A

Rest
Anti-inflammatory medications
Surgery

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59
Q

What are the dental related risk factors for lateral epicondylitis?

A

Too straight/overextended elbow
Reaching across client

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60
Q

How to prevent lateral epicondylitis?

A

Avoid wrist extesion
Maintain neutral wrist position
Use proper clinician positions
Alter intrument grasp
Avoid repetitive crossing of arms across the chest
Avoid leaning on the elbow

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61
Q

What is the radial nerve entrapped in the radial tunnel?

A

Radial tunnel syndrome

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62
Q

What are the symptoms of radial tunnel syndrome?

A

Increased tenderness and pain at the lateral side of the elbow when the arm and elbow are used

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63
Q

How to prevent radial tunnel syndrome?

A

Maintain proper wrist position and motion

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64
Q

What syndrome affects ulnar nerve and it crosses behind the elbow?

A

Cubital tunnel syndrome

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65
Q

What are the symptoms of cubital tunnel syndrome?

A

Pain and numbness in the elbow
Tingling, especially in little and ring fingers
Pain that is sometimes relieved when straightening the elbow

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66
Q

What are the risk factors for cubital tunnel syndrome?

A

Prolonged gripping of grasping instruments palm
Holding the elbow in fixed position

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67
Q

How to prevent cubital tunnel syndrome?

A

Maintain neutral elbow position
Alter instrument grasps
Avoid prolonged used of palm grasp
Avoid repetitive crossing of arms across the chest
Avoid leaning on elbow

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68
Q

What are the rotator cuff injuries?

A

Rotator cuff tendontitis
Rotator cuff tears

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69
Q

What are the symptoms of rotator cuff injuries?

A

Pain when lifting arms 60-90 degrees
Shoulder pain

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70
Q

What are the dental related risk factors of rotator cuff injuries?

A

Remaining in one position for too long

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71
Q

How to prevent rotator cuff injuries?

A

Avoid repetitive twisting and reaching
Maintain neutral shoulder and arm positions
Use proper clinician positions

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72
Q

What results from immobility of the shoulder due to severe shoulder injury/surgery or repeated occurences of rotator cuff tendonitis?

A

Adhesive capsulitis

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73
Q

How to prevent shoulder injuries?

A

Avoid repetitive twisting and reaching
Maintain neutral shoulder and arm positions
Use proper clinician positions

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74
Q

What syndrome involves the cervical muscles of the trapezius muscle?

A

Tension neck syndrome

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75
Q

What are the symptoms of tension neck syndrome?

A

Pain/stiffness of neck or between shoulder blades
Hardness in neck
Limited neck movement
Muscle tightness/tingling

76
Q

How to prevent tension neck syndrome?

A

Good posture
Correct client/clinician positioning
Exercise and stretch muscles

77
Q

What leads to the degeneration of the cervical spine, causing osteoarthritis of the cervical spine, disk degeneration, and herniation?

A

Cervical spondylosis and cervical disk disease

78
Q

What are the symptoms of cervical spondylosis?

A

Crepitus in neck
Stiffness
Limited motion
Pain in upper neck
Pain scpula
Muscle spasms

79
Q

What are the dental related risk factors for neck and back injuries?

A

Improper neck position
Repetitve or continued twisting and rotating of the spine

80
Q

What are used to prepare calculus deposits before removal with another instrument?

A

Periodontal files

81
Q

Are periodontal files area specific?

A

Yes

82
Q

Are periodontal files widely used?

A

No

83
Q

What has largely replaced periodontal files?

A

Ultrasonic scalers

84
Q

What does the rigid shank of the periodontal file limit?

A

Tactile information

85
Q

What can the large circumference of base limits cause?

A

Excessive stretching of soft tissues

86
Q

What type of strokes are required when using a periodontal file?

A

Firm lateral pressure with pull stroke

87
Q

Should a periodontal file be used at the base of a pocket?

A

No. It can traumatize the JE

88
Q

How to adapt the periodontal file when in use?

A

Working end to deposit while resting the lower shank against the tooth to provide stability and leverage. Entire face should be flat against the deposit.

89
Q

After the deposit is crushed/roughened what do you do?

A

Remove remaining deposit with curette

90
Q

What are the adaptations to instrument design modifications?

A

Shank length
Rigidity of shank
Size or working end (mini)

91
Q

What is an extended instrument shank?

A

Shank is 3mm longer than the standard currette to access pockets greater than 4mm
Working end is 10% thinner to reduce tissue distention

92
Q

What are disc shaped currettes?

A

New currettes with a disc shape designed working end that has the entire circumference as a cutting edge

93
Q

What are diamond coated instruments?

A

No cutting edge but coated with a fine diamond grit around the tip that are used like an emery board. Good for conservative root planing, polishing root surfaces and furcation areas

94
Q

How to use diamond coated instruments?

A

With light strokes in various directions

95
Q

What is a subgingival dental endoscope?

A

A long, flexible, tubular device with a fiber optic light and video camera attached that views and examines periodontal pockets

96
Q

What magnification does a subgingival dental endoscope show?

A

20-40x

97
Q

Are subgingival dental endoscopes recommended for routine subginginval debridement? Why or why not?

A

No. Too time consuming

98
Q

What are the classifications of furcations?

A

Class I
Class II
Class III
Class IV

99
Q

What is Class I furcation?

A

Probe cannot enter the furcation area but can feel concavity with probe tip

100
Q

What is a Class II furcation?

A

Probe is partially able to enter the furcation about 1/3 the width of the tooth, but cannot pass completely through

101
Q

What is a Class III furcation?

A

When the probe passes completely through furcation

102
Q

What is a Class IV furcation?

A

Same as class III except the furcation is visible due to recession

103
Q

When is it okay to use advanced fulcrums?

A

Selectively in areas of limited access such as when working in a narrow, deep periodontal pocket

104
Q

What is a modified intraloral fulcrum?

A

A fulcrum with an altered point of contact between the middle and ring fingers in the grasp but not the same as a split fulcrum

105
Q

What type of fulcrum is when the finger rest is established on the opposite side of the arch from the treatment area?

A

Cross arch fulcrum

106
Q

What type of fulcrum is established on the opposite arch from the treatment area?

A

Opposite arch fulcrum

107
Q

What type of fulcrum is when a finger of the non-dominant hand serves are the resting point for the dominant hand?

A

Finger-on-finger

108
Q

What are the advantages of extraoral fulcrums?

A

Easier to access maxillay 2nd and 3rd molars
Easier to access deep pockets
Improved parallelism of lower shank to molar teeth
Facilitiates neutral wrist position for molar teeth

109
Q

What are the disadvantages of extraoral fulcrums?

A

Require greater degree of muscle coordination and instrumentation skill
Greater risk of instrument stick
Reduced tactile information
Not well tolerated by patients with TMJ issues

110
Q

How should the grasp be altered for extraoral fulcrums?

A

Clinician should grasp the instrument handle farther away from the working-end

111
Q

What are the steps for instrumentation of roots?

A

Begin with root trunk, distal currette, the mesial, then root branches. Treat each root branch as it’s own, distal currette then mesial.

112
Q

Why use horizontal strokes on roots?

A

To remove deposits from root concavities and depressions

113
Q

Why are vertical strokes not effective on roots?

A

The working-end often “spans across” the root concavity, missing the deposit

114
Q

Why can the gracey 11 not be used for a horizontal stoke on the mesial root surface?

A

The cutting edge does not adapt to the mesial surface

115
Q

What should be used instead of the gracey 11 for a horizontal stroke on the mesial root surface?

A

Gracey 12 in a toe down position

116
Q

What is used on the distal surfaces of the roots for a vertical stroke?

A

G13

117
Q

What is used on the mesial surface of the roots for a vertical stroke?

A

G11

118
Q

What is used on the distal surface of the roots for a horizontal stroke?

A

G14

119
Q

What is used on the mesial surface of the roots for a horizontal stroke?

A

G12

120
Q

What are the commonly missed areas of debridement?

A

Proximal surfaces

121
Q

How to ensure you get the proximal surfaces during debridement?

A

Roll your instrument so that the last 2mm of the tip is accessing the deepest part of the proximal surface (COL area)

122
Q

What is characterized by short, sharp pain arising from exposed dentin that occurs in response to stimuli, typically thermal (both hot and cold), tactile, or chemical, and that cannot be ascribed to any other form of dental defect or pathology?

A

Dentinal hypersensitivity

123
Q

What is the objective of root planing?

A

To remove as little tooth structure as possible

124
Q

Where is dentinal hypersensitivity most prevalent?

A

Buccal cervical regions of teeth

125
Q

What is the most common desensitizing agent in over the counter toothpastes?

A

Potassium Nitrate

126
Q

True or False: Clients with inadequate SPT after successful regenerative therapy have 50 fold increase in risk of probing attachment loss compared with those who have regular visits.

A

True

127
Q

What does NSPT stand for?

A

Nonsurgical Periodontal Therapy

128
Q

What is NSPT?

A

Removal and control of oral biofilm through self-care and professional periodontal debridement, supplemented by adjunctive therapy with chemotherapeutics or host modulation agents as needed, for the treatment of periodontal disease involving natural teeth and implant replacements

129
Q

What is host modulation treatment?

A

Treatment concept that reduces tissue destruction and stablizes or even regenerates inflammatory tissue by modifying host response factors.

130
Q

What is the most important factor in the outcome of plaque biofilm on the periodontium?

A

Host response factors - the client’s immune system

131
Q

What characterizes health?

A

The absence of inflammation, assessed by no erythema or edema, suppuration, or bleeding on probing

132
Q

Is oral prophylaxis therapeutic?

A

No, it is preventative

133
Q

When is oral prophylaxis performed?

A

When periodontal health or bio-induced gingivitis is diagnosed

134
Q

What is periodontal debridement?

A

The removal of all subgingival oral biofilm and its by-products

135
Q

What is scaling?

A

The instrumentation of the crown and root to remove oral biofilm, calculus, and stains

136
Q

What is the restoration of gingival health, a reduction in pocket depth, and a gain in or maintenance of a stable clinical attachment level?

A

Therapeutic endpoint

137
Q

What does SRP stand for?

A

Scaling and root planing

138
Q

What is the goal of periodontal debridement?

A

Tissue healing with minimal iatrogenic damage to the soft tissue and the cementum

139
Q

What is a co-therapist in NPST?

A

The client

140
Q

What is critical in planning the course of NSPT care and predicting the prognosis?

A

Determining the severity of the disease and its progression rate

141
Q

What is periodontal disease activity?

A

Involves periods of inactivity and exacerbation

142
Q

What period of periodontal disease have reduced host inflammatory responses and little to no loss of bone and connective tissue attachment?

A

Inactivity

143
Q

What period of periodontal disease includes unattached oral biofilm and anaerobic bacteria with other factors and the host’s response, resulting in loss of bone and connective tissue attachment, createing deeper periodontal pockets?

A

Activity

144
Q

What are the four phases of periodontal therapy?

A

Phase I: Nonsurgical Phase
Phase II: Surgical Phase
Phase III: Restorative Phase
Phase IV: Maintenance Phase

145
Q

What happens during Phase I - Nonsurgical Phase?

A

Plaque control
OHI
Removal of calculus and root planing
Antimicrobial therapy
Occlusal therapy
Minor ortho
Provisional splinting or prostho
Correction of restos and prsotho irritational factors

146
Q

What happens during Phase II - Surgical Phase?

A

Periodontal therapy including placement of implants
Endo

147
Q

What happens during Phase III - Restorative Phase?

A

Dental restos, fixed or removable prosthos, re-evals

148
Q

What happens during Phase IV - Maintenance phase?

A

Recares

149
Q

Is Phase IV - Maintenance Phase considered active therapy?

A

No

150
Q

How long does Phase IV - Maintenance Phase last?

A

Lifetime

151
Q

What is the goal of perio maintenance?

A

To prevent or minimize recurrence and progression of periodontal disease in persons who ave been treated for gingivitis, periodontitis, and peri-implantitis
To prevent or reduce tooth loss
To increase the probability of locating and treating other disease and conditions

152
Q

What are the peridontal maintenance intervals?

A

3 months

153
Q

What is the main focus of NSPT?

A

Oral self care

154
Q

What are the systemic risk factors of periodontal disease?

A

Tobacco/smoking
Diseases/conditions
Hormonal
Medications
Immune conditions
Poor nutrition
Stress
Systemic infections
Blood disorders
Allergic reactions

155
Q

What are the local risk factors of perdiodontal disease?

A

Calculus
Dental caries
Tobacco/Smoking
Poor self care
Mature biofilm
Malpositioned teeth, groove, concavities
Abrasion
Crowding
Poor restos
Open contacts
Crown contours
Appliances
Oral jewellry
Recession
Frenum pulls causing recession
Gingival enlargement, pseudopockets
Occlusal trauma

156
Q

Is pain-control and/or anxiety management strategies a major consideration for NSPT?

A

Yes

157
Q

Does NSPT take more time than oral prophylaxis or PM?

A

Yes

158
Q

What is the difference between NSPT and oral prophylaxis?

A

NSPT treats active disease while oral prophlaxis is preventative

159
Q

What are the supportive interventions for NSPT?

A

Overhang removal
Densensitization
Dietary assessment and risk management
Occlusal therapy

160
Q

What are the therapeutic procedures in NSPT?

A

Mechanical nonsurgical pocket therapy
Chemotherapy for peridontal disease
Full mouth disinfection

161
Q

What is full mouth disinfection?

A

Scaling and root planing all of pockets within a 24-hour period which may include chlorhexidine 0.12% use followed by twice daily 30 second usage.

162
Q

What is the basis of successful NSPT?

A

The thoroughness of the periodontal debridement and the client’s standard of self care.

163
Q

How are instruments selected?

A

Type of deposit or biofilm being removed
Pocket depth
Inflammation
Tissue tone
Access
Root morphology
Pocket topography

164
Q

When should perio surgery be considered?

A

When pockets of 6mm of greater are adjacent to furcations and mobility exists

165
Q

What factors should be considered when considering a referral to periodontist?

A

Type and severity of disease
Dental hygienist’s acquired experiences
Time allotted to maintain periodontally involved cases

166
Q

When should re-evaluation be done?

A

4-6 weeks

167
Q

What is the re-eval appointment?

A

Compares current perio condition to the intitial perio assessment to determine if the client has responded to treatment

168
Q

What will be determined at the re-eval appointment?

A

If the client has responded or not to treatment.

169
Q

What to consider if no response to treatment?

A

Client compliance
Different therapeutic agents
Appointment intervals
Referrals
Medical referral for systemic factors

170
Q

What does the DC re-eval appointment include?

A

MH update
Vitals if indicated
EO/IO update in ROC
Review education
Assess soft and hard deposits (including PR)
Reassess conditions of the soft tissues and compare to previous
RDH to evaluate student
All findings discussed with client
Full debridement/deplaquing and have RDH assess. If extensive deposits, bring client back for recare
Follow up about any referrals made before

171
Q

What strengthening exercise should you use to strengthen the lumbar spine?

A

Pelvic Tilt

172
Q

How do you do a pelvic tilt exercise?

A
  1. Lie on your back or stand flat against the wall
  2. Keep knees slightly bent
  3. Flatten and press back into floor or wall
  4. Hold position briefly
  5. Repeat
173
Q

What strengthening exercise should you use to safeguard the lumbar curve?

A

Hyperextension

174
Q

How do you do a hyperextension exercise?

A
  1. Lie on your stomach
  2. Arch your body backwards in an upward position
  3. Hold position briefly
  4. Repeat
175
Q

What strengthening exercise do you use to stretch the lumbar spine?

A

Knee-to-Chest

176
Q

How do you do a knee-to-chest exercise?

A
  1. Lie on your back
  2. Bring both knees to your chest
  3. Hold position briefly
  4. Return to original position without straightening legs fully
  5. Repeat
177
Q

What strengthening exercise do you use to strengthen abdominal muscles?

A

Sit-ups

178
Q

How do you do sit-ups exercise?

A
  1. Lie on your back
  2. Bend both knees
  3. Support neck
  4. Gently raise shoulders toward knees
  5. Hold position briefly
  6. Return to original position
  7. Repeat
179
Q

What strengthening exercise do you do to relieve lower back pain?

A

Suspend From a Bar

180
Q

How do you a suspend from a bar exercise?

A
  1. Firmly grasp bar
  2. Suspend your body with bar; slowly lift feet
  3. Hold position for a short time
  4. Repeat
181
Q

What strengthening exercise do you do to reverse poor posture?

A

Doorway Stretch

182
Q

How do you do a doorway stretch exercise?

A
  1. Stand in front of an open door
  2. Place your hands on either side of doorframe
  3. Gently allow your body to learn forward through doorway
  4. Hold position
  5. Return to original position
  6. Repeat
183
Q

What strengthening exercise do you do to stretch the cervical spine and relieve neck muscle strain?

A

Neck Isometric

184
Q

How do you do a neck isometic exercise?

A
  1. Grasp your hands behind your back
  2. Gently press your head back
  3. Do not allow any backward movement
  4. Hold position briefly
  5. Repeat
185
Q

What strengthening exercises do you do to strengthen the hand and finger muscles?

A

Rubber Ball Squeeze
Rubber Band Stretch

186
Q

How do you do a rubber ball squeeze exercise?

A
  1. Firmly grasp a rubber ball in your hand
  2. Gently squeeze
  3. Hold position briefly
  4. Repeat
187
Q

How do you do a rubber band stretch exercise?

A
  1. Extend a rubber band between fingers of your hand
  2. Gently stretch rubber band until you feel resistance
  3. Hold position briefly
  4. Release rubber band
  5. Repeat

Hygiene Theory IV (2 decks)

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