week 6 - elbow, wrist and hand Flashcards
what are some subjective questions for the elbow, wrist and hand?
aggs/eases
-gripping, pushing, pulling, twisting
-occupation
-physical activity
-hobbies
onset
-insidious
-trauma
neurological symptoms
cervical symptoms
What observations should you make of the elbow, wrist and hand?
posture/positioning
muscle bulk
inflammatory signs
-redness
-swelling
-bruising
deformities
maladaptive patterns
Which accessory movements are available at the elbow?
medial glide
lateral glide
longitudinal distraction
What does Mill’s test test for?
lateral epicondylalgia (tennis elbow)
How do you carry out Mill’s test?
palpate proximal common wrist extensor tendon
flex the wrist and extend the elbow
What is a positive test for Mill’s test?
Reproduce lateral elbow pain
What does Cozen’s test test for?
lateral epicondylalgia (tennis elbow)
What is a positive result for Cozen’s test?
reproduce lateral elbow pain
What does Phalen’s test test for?
carpel Tunnel syndrome
What is a positive test for Phalen’s test?
Paraesthesia reproduced in the cutaneous distribution of the median nerve
What does Tinel’s test test for?
Carpel tunnel syndrome
What is a positive test for Tinel’s test?
Paraesthesia preproduced in the cutaneous distribution of the median nerve
What does Finkelstein’s test test for?
DeQuervain’s Tenosynovitis
How do you carry out Finkelstein’s test?
Patient in sitting or standing
actively flexes the thumb maximally and wrap fingers over thumb making a fist
place wrist into ulnar deviation to stretch APL and EPB
What is a positive Finkelstein’s test?
Pain at APL and EPB
Name some common signs and symptoms of lateral epicondylalgia
gradual onset - overloading
pain on lateral elbow
painful with gripping, wrist extension and pronation/supination
thickening of the proximal common extensor tendon
pain and reduced strength with gripping, wrist extension and pronation/supination
tender on palpation of lateral epicondyle and wrist extensors
What are some common signs and symptoms of carpel tunnel syndrome?
pain, paraesthesia and/or anaesthesia on cutaneous distribution of the median nerve
symptoms often worse at night
difficulty gripping and weakness in hands
reduced grip strength
pain on wrist extension
positive Phalen’s test
Thennar atrophy/wastage
Name some common signs and symptoms of DeQuervain’s Tenosynovitis
Gradual onset
aggravated by gripping and use of thumb with radial deviation
may be some swelling/thickening present
weakness and pain on active thumb extension and radial deviation of the wrist
What movements occur at the elbow?
flexion
extension
pronation
supination
What movements occur at the wrist?
flexion
extension
radial deviation
ulna deviation
What movements occur at the hand?
finger flexion
finger extension
finger abduction
thumb opposition
How do you carry out Cozan’s test?
patient in sitting or standing
place arm in elbow flexion and pronation
palpate proximal common wrist extensor tendon
ask the patient to extend their wrist against your resistance
How do you carry out Phalen’s test?
patient in sitting or standing
flex the patient’s wrist and place both dorsal surfaces together
their position is held for 60 seconds or until symptoms are reproduced
How do you carry out TInnel’s test?
patient in sitting or standing
lightly tap over the medial nerve within the carpal tunnel for 60 seconds or until symptoms are reproduced
