Week 4: Assessment of Grip, Pinch, Edema Flashcards
What happens as axons regenerate through hand and Tinel’s sign occurs?
Hypoesthesia develops, hypersensitivity is positive sign of nerve growth
Why is sensibility testing performed?
Assess recovery of nerve following laceration and repair as well as determine presence of nerve compression syndrome and return of nerve function
What are reliable and sensitive tests for early detection of carpal tunnel syndrome?
Semmes-Weinstein and electrical testing
How is moving touch tested?
Eraser placed in area of normal sensibility and moved to dotal fingertip, client notes when perception of stimulus changes (light and heavy pressure applied)
T/F: Semmes-Weisein is most accurate instruments for assessing cutaneous pressure thresholds
True
How should you perform monofilament pressure test?
- start in normal range than increase diameter range
- 2/3 correct are needed in one area to be considered having intact sensibility
- Need to place monofilaments randomly rather than in one area
- Graded from light touch (2.83+) to loss of protective sensation (-4.56)
Guidelines for static 2 point discrimination test
- vision occlude
- area of normal sensation tested as reference
- calipers set 10 mm apart and randomly applied, starting at fingertip and move proximally and longitudinally in line with digital nerves with one or two points touching
- distance decreased until client can no longer feel 2 distinct points and that distance is measured
Need to have 4/5 responses right
What is normal two point discrimination at fingertip?
6 mm or less
What does moving 2 point discrimination measure?
Innervation density of quickly adapting nerve fibers for touch (more sensitive than static test)
How is moving 2 point discrimination tested?
- vision occluded
- area of normal sensation tested as reference
- fingertip is supported by examining table or examiner’s hand
- caliper, separated 5-8mm is moved longitudinally from proximal to distal in linear fashion along fingertip. One and two points are randomly alternated. Client must correctly identify stimulus in 7/8 responses before proceeding to smaller value.
Test repeated down to separation of 2 mm.
T/F: 2 point values increase with age in both sexes with smallest values 10-30 y/o
True
T/F: Women have smaller values than men
True
T/F: There is no diff. between non dominant and dominant hand for 2 point discrimination
true
What nerves does Moberg Pickup Test test?
Median nerve injury or median and ulnar
What are steps to Moberg Pick Up test?
- 9 or 10 small objects placed on table, client asked to place them one at a time in small container as quickly as possible while looking at them. Timed
- Test repeated for opposite hand with vision
- Test repeated for each hand with vision occluded.
- Client asked to ID each object one at a time with and without vision
Why do we look at hand volume?
Measuring edema important, look at it at different times of day to measure effects of rest versus activity and effects of splinting or intervention to reduce edema
What is used to assess hand edema?
Volumeter
What variables have been shown to decrease accuracy of voltmeter?
- use of faucet or house that introduces air into tank during filling
- Movement of arm within tank
- Inconsistent pressure on stop rod
- Use of voltmeter in variety of places
T/F; Increased volume indicates presence of edema
True
How is edema eval performed?
- plastic voltmeter filled and allowed to empty into large beaker until water reaches spout level
- client immerses hand in it and keep hand in mid position
- hand lowered until rests between middle nd ring fingers on dowel rod. Hand cannot press onto the rod
- Hand remains still until no more water drips into beaker
- water poured into graduated cylinder and measure level
T/F: strength testing done right after surgery/trauma
False. Done after healing phase of trauma
What is used to assess grip strength?
Adjustable handle dynamometer
How to use dynamometer?
1) seated with shoulder adducted and neutrally rotated
2) elbow flexed at 90
3) forearm in neutral position
4) wrist between 0 and 30 extension and between 0-15 ulnar deviation
3 trials taken of each hand and mean of 3 is reported. Noninjured hand used for comparison.
How to assess pinch?
Pinch gauge
What are three types of pinch?
Two point (thumb tip and index finger Lateral pinch 3 point pinch (thumb tip to tips of index and middle)
3 trials bilaterally
Why is assessment of hand function or performance important?
BC physical assessment does not measure client’s ingenuity and ability to compensate for loss of strength, ROM, sensation or presence of abnormalities
What test is this? Provide measurements of standardized tasks with norms for client comparison. ex) 7 subtests, write short sentence, turn cards, pick up objects, etc.) Good for overall hand function
Jebsen Test of Hand Function
What test is this? measure ability to perform general arm and hand activities used in daily living. 6 parts: grasping, lifting two pipes, putting small washer over a nail, pour water in pitcher
Quantitative Test of UE Function
Other tests for hand dexterity?
Crawford Small Parts Dext. Test
Bennet Hand Tool Dex. Test
Purdue Pegboard Test
Minnesota manual Dex Test
