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msk 3 midterm > wrist and hand exam > Flashcards

wrist and hand exam Flashcards

1
Q

FOOSH can lead to

A

Scaphoid or distal radius (Colle’s) fracture
Lunate dislocation

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2
Q

Clicking and popping sounds in a joint, especially after a FOOSH injury or repetitive use, can be signs of joint instability:

A

Ligament injury or tear – Damage to stabilizing ligaments (e.g., scapholunate ligament in the wrist) can cause abnormal movement of the bones

Damage to articular cartilage (such as a labral tear in the shoulder)

Partial or complete dislocation can lead to abnormal positioning and movement of bones

Tendons that have become misaligned or irritated (like the extensor carpi ulnaris tendon in the wrist)

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3
Q

In an inflammatory condition, the following symptoms typically appear:

A

Insidious onset of pain – The pain gradually develops over time, rather than being linked to a specific traumatic event or mechanical injury.

Redness – The affected area may appear red due to increased blood flow from the inflammatory response.

Swelling – Fluid accumulation or joint effusion often occurs, leading to noticeable swelling.

No mechanism of injury (MOI) – The pain and other symptoms arise without a clear cause, often linked to autoimmune or systemic issues rather than trauma or overuse.

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4
Q

Insidious hand pain refers to pain that develops gradually over time, without an obvious injury or traumatic event. Possible causes of insidious hand pain include:

A

Osteoarthritis
Rheumatoid arthritis
Carpal Tunnel Syndrome (CTS)
Tendinitis or tenosynovitis
Trigger finger
Gout
Infective arthritis
Polyarthritis
Vascular disorders

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5
Q

Osteoarthritis –

A

Degeneration of joint cartilage, commonly affecting the thumb (CMC joint), causing stiffness, pain, and swelling.

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6
Q

Rheumatoid arthritis –

A

An autoimmune condition that leads to joint inflammation, particularly in the small joints of the hands, often accompanied by swelling, stiffness, and deformities.

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7
Q

Carpal Tunnel Syndrome (CTS) –

A

Compression of the median nerve in the wrist, resulting in pain, numbness, and tingling that may worsen over time, especially at night.

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8
Q

Tendinitis or tenosynovitis –

A

Chronic overuse or repetitive strain leading to inflammation of the tendons, causing gradual pain and swelling (e.g., De Quervain’s tenosynovitis).

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9
Q

Trigger finger –

A

Inflammation or thickening of the tendons, making finger movement painful and causing locking or catching.

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10
Q

Gout -

A

Uric acid crystals accumulate in joints, often due to high uric acid levels in the blood

Sudden, severe attacks of pain, redness, and swelling, commonly affecting the small joints of the fingers or wrists

Gout flares often occur at night and can be triggered by diet, alcohol, or dehydration

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11
Q

Infective (Septic) Arthritis -

A

Bacterial, viral, or fungal infection in the joint, leading to inflammation

Acute onset of severe pain, warmth, redness, and swelling, often accompanied by fever and systemic symptoms

The affected joint may become stiff and difficult to move.

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12
Q

Polyarthritis -

A

Inflammation of multiple joints, often associated with autoimmune conditions like rheumatoid arthritis, lupus, or psoriatic arthritis

Symmetrical involvement of multiple joints, including the hands, with swelling, pain, and morning stiffness lasting more than 30 minute

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13
Q

Vascular Disorders -

A

Compromised blood flow due to conditions like Raynaud’s phenomenon, peripheral artery disease (PAD), or vasculitis

Cold, pale, or bluish fingers with pain, tingling, or numbness

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14
Q

common deformities associated with rheumatoid arthritis (RA):

A

Boutonniere Deformity of thumb

Ulnar Deviation of Metacarpophalangeal (MCP) Joints

Swan-Neck Deformity of fingers

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15
Q

Boutonniere Deformity

A

Flexion of the proximal interphalangeal (PIP) joint and hyperextension of the distal interphalangeal (DIP) joint

Cause: Damage or rupture of the central slip of the extensor tendon at the PIP joint

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16
Q

Ulnar Deviation of Metacarpophalangeal (MCP) Joints

A

Deviation of the fingers toward the ulnar side (pinky side) at the MCP joints

Cause: weakening of joint capsules and ligaments leads to drifting of the fingers toward the ulnar side

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17
Q

Swan-Neck Deformity

A

Hyperextension of the PIP joint and flexion of the DIP joint

Cause: Imbalance between the flexor and extensor mechanisms of the finger

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18
Q

Resting position of the hand:

A

Finger flexion greater moving from radial to ulnar direction, normal arches (longitudinal/transverse), thumb slight abduction

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19
Q

Muscle wasting:

A

thenar (median n)

1st dorsal interosseous muscle (C7)

hypothenar (ulnar n)

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20
Q

Thenar Muscle Wasting (Median Nerve)

A

abductor pollicis brevis, flexor pollicis brevis, and opponens pollicis

Compression or damage to the median nerve, often due to conditions like carpal tunnel syndrome (CTS)

the rounded area at the base of the thumb), along with weakness in thumb opposition, abduction, and flexion

struggle with gripping or pinching motions

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21
Q

First Dorsal Interosseous Muscle Wasting (C7)

A

primarily innervated by the ulnar nerve, but involvement of the C7 nerve root can indirectly impact this muscle

cervical radiculopathy, nerve compression, cubital tunnel syndrome

Wasting between the thumb and index finger (first web space), leading to weakness in finger abduction and reduced pinch strength

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22
Q

Hypothenar Muscle Wasting (Ulnar Nerve)

A

abductor digiti minimi, flexor digiti minimi brevis, and opponens digiti minimi

ulnar nerve entrapment at the elbow (cubital tunnel syndrome) or at the wrist (Guyon’s canal syndrome)

Wasting of the hypothenar eminence (the rounded area at the base of the little finger), along with weakness in movements of the pinky finger, including abduction, opposition, and flexion

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23
Q

Complex Regional Pain Syndrome (CRPS)

A

often develops after an injury (e.g., a fracture or surgery) and involves persistent pain, swelling, and autonomic disturbances.

Vasomotor changes: Abnormal skin temperature (cold or warm), skin color changes, and altered sweating.

Trophic changes: Shiny skin, hair loss, brittle or ridged fingernails, and skin atrophy.

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24
Q

Peripheral Nerve Damage (Neuropathy)

A

Conditions like diabetic neuropathy or entrapment syndromes (e.g., carpal tunnel syndrome) can lead to impaired autonomic function.

The affected nerves may cause vasomotor symptoms like temperature differences and trophic changes, including loss of hair and nail brittleness in the distribution of the damaged nerve.

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25
Q

Peripheral Artery Disease (PAD)

A

Decreased blood flow due to arterial blockages can lead to trophic changes, such as shiny skin, hair loss on the legs, brittle nails, and poor wound healing.

Cold extremities or a noticeable temperature difference between limbs can also be observed.

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26
Q

Raynaud’s Phenomenon

A

A vasomotor disorder triggered by cold or stress, causing changes in blood flow to the fingers or toes.

Prolonged cases may lead to trophic changes like brittle nails, thinning skin, and even ulcers due to poor circulation.

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27
Q

Autonomic Neuropathy

A

Seen in conditions like diabetes or autoimmune diseases, where the autonomic nervous system is damaged, leading to issues with sweating regulation (too much or too little) and temperature dysregulation.

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28
Q

Chronic Nerve Compression

A

Prolonged compression, such as in carpal tunnel syndrome or thoracic outlet syndrome, may impair blood supply and autonomic function, causing vasomotor and trophic changes, including changes in sweating, skin texture, and nail growth.

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29
Q

Heberden’s Nodes

A

Location: Affect the distal interphalangeal (DIP) joints (the joints closest to the tips of the fingers).

Associated with: Osteoarthritis of the DIP joints.

Appearance: These are hard, bony swellings that develop over time due to cartilage degeneration and the formation of osteophytes (bone spurs).

Symptoms: They can cause stiffness, reduced range of motion, and pain, although some people may have painless nodes.

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30
Q

Bouchard’s Nodes

A

Location: Affect the proximal interphalangeal (PIP) joints (the middle joints of the fingers).

Associated with: Osteoarthritis of the PIP joints.

Appearance: Similar to Heberden’s nodes but occur at a different location. These bony enlargements also result from cartilage breakdown and osteophyte formation.

Symptoms: Similar to Heberden’s nodes, they may cause pain, stiffness, and difficulty with finger movement.

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31
Q

Spoon shaped fingernails =

A

fungal infection, anemia, iron deficiency, diabetes, long time injury, psoriasis

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32
Q

Clubbed nails =

A

(hypertrophy of nail bed, COPD, congenital heart defect, cor pulmonale)

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33
Q

+ Froment sign =

A

inability to pinch between thumb and index finger without flexion of the DIP occurring- weakness of AP, FPB

assess for ulnar nerve dysfunction, particularly indicating weakness in the adductor pollicis (AP) and flexor pollicis brevis (FPB) muscles

If these muscles are weak or paralyzed due to ulnar nerve damage, compensation occurs through the flexor pollicis longus (FPL), which is innervated by the median nerve.

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34
Q

Intrinsic Minus –

A

combined ulnar and median nerve loss

Claw Hand): Caused by intrinsic muscle weakness, leading to MCP hyperextension and PIP/DIP flexion (e.g., ulnar nerve injury)

weakness or paralysis of the intrinsic muscles (interossei and lumbricals)

When these muscles are weakened, the extrinsic flexors and extensors dominate

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35
Q

Intrinsic Plus –

A

90 dg MCP flex, PIP/DIP ext, interossei and lumbricals at shortest position, common in patients with RA

Caused by intrinsic muscle dominance, leading to MCP flexion and PIP/DIP extension (e.g., intrinsic muscle spasticity or extrinsic muscle weakness)

Rheumatoid arthritis or intrinsic muscle contractures may lead to this position due to joint or muscle changes

“safe position” for hand splinting

“lumbrical grip”

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36
Q

Limited Extension of hand:

A

Potential Causes: Joint stiffness, contractures, arthritis, or tendon injuries.

Possible Conditions: Rheumatoid arthritis, Dupuytren’s contracture, tenosynovitis

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37
Q

Limited Flexion of hand:

A

Potential Causes: Weakness in flexor muscles, pain, or joint damage.

Possible Conditions: Tendon injuries, flexor tendinitis, neurological issues.

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38
Q

Pain on Opening the Hand:

A

Potential Causes: Flexor tendon issues, joint inflammation, or irritation.

Possible Conditions: Tenosynovitis, rheumatoid arthritis, or trigger finger.

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39
Q

Pain on Closing the Hand:

A

Potential Causes: Weakness or strain in flexor muscles, joint pain, or structural issues.

Possible Conditions: Tendonitis, carpal tunnel syndrome, or osteoarthritis.

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40
Q

Importance of Pad-to-Pad Mobility

A

allows for precise pinching, gripping, and manipulation of objects

Test each finger individually

Restricted Mobility: Suggests potential issues with joint range of motion, tendon flexibility, or muscle strength, which may impact functional tasks.

Arthritis, joint deformities, or contractures can limit finger extension and thumb movement.

Tendon injuries or tightness can restrict the ability to bring the pads together effectively.

Weakness or coordination problems due to nerve damage or muscle dysfunction can affect pinching ability.

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41
Q

most functional activities, having at least ___ of opening between the thumb and fingers is crucial

A

5 cm

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42
Q

The ability to make three different fists:

A

standard
straight
hook

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43
Q

Standard fist

A

Power

The fingers are curled into the palm, and the thumb wraps around the outside, forming a tight grip

checks for the integrity of the flexor digitorum profundus (FDP) and flexor digitorum superficialis (FDS) tendons

Difficulty forming this fist may indicate damage to flexor tendons, median or ulnar nerve pathology, or joint issues like arthritis

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44
Q

Hook Fist

A

(placing fingertips onto MCP joints)

proximal interphalangeal (PIP) and distal interphalangeal (DIP) joints are flexed, while the metacarpophalangeal (MCP) joints remain extended

primarily tests the function of the flexor digitorum profundus (FDP) tendons, which flex the DIP joints

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45
Q

Straight Fist (Lumbrical Plus)

A

(placing fingertips on the thenar and hypothenar eminences). The ability to flex the fingers to within 1–2 cm of the distal anterior (palmar) crease is an indication of functional range of motion for many hand activities

MCP joints are flexed while the PIP and DIP joints are extended. The fingers are positioned flat against the palm without curling

tests the lumbrical muscles and the flexor digitorum superficialis (FDS) tendons, which flex the PIP joints without engaging the FDP

nability to form this fist suggests issues with the FDS tendons or median nerve dysfunction, as the FDS is crucial for isolated PIP joint flexion

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46
Q

Edema assessment:

A

“Volumetry”= water displacement as a measure of volume, is considered the gold standard for measuring hand size.

Circumferential measurements

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47
Q

Loose wrist/hand:

A

wrist instability:
DRUJ
VISI/DISI
UCL sprain
CMC OA
RA

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48
Q

Distal Radioulnar Joint (DRUJ) Instability

A

Injury or laxity of the ligaments stabilizing the DRUJ, commonly due to trauma (like a FOOSH injury) or degenerative changes

Pain on the ulnar side of the wrist, especially during rotational movements like pronation and supination

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49
Q

Volar Intercalated Segment Instability (VISI)

A

collapse of the lunate in a volar direction (towards the palm), often due to ligament injuries = lunotriquetral ligament

Wrist pain and instability, especially with wrist flexion and ulnar deviation

may not be as noticeable as a DISI

50
Q

Dorsal Intercalated Segment Instability (DISI)

A

collapse of the lunate dorsally (towards the back of the hand), due to injury to the scapholunate ligament

Pain and instability, especially with wrist extension

51
Q

Ulnar Collateral Ligament (UCL) Sprain

A

“skier’s thumb” or “gamekeeper’s thumb

forceful abduction or hyperextension of the thumb

Pain and swelling at the base of the thumb, especially with pinching or gripping

52
Q

Carpometacarpal Osteoarthritis (CMC OA)

A

Degenerative changes in the thumb CMC joint (the trapeziometacarpal joint), leading to cartilage breakdown and joint instability

Pain at the base of the thumb, especially with pinching and gripping, along with swelling, joint stiffness, and visible deformity

53
Q

Rheumatoid Arthritis (RA)

A

autoimmune condition that leads to chronic inflammation of the joints

Symmetrical swelling, pain, and instability in multiple joints of the hands and wrists

deformities include ulnar deviation of the MCP joints, boutonniere deformity, and swan-neck deformity

54
Q

Stiff wrist/hand:

A

OA
post-immobolization
Post-fx
post-operative
CMC OA
RA

55
Q

Post-Immobilization

A

Stiffness following a period of immobilization (e.g., casting or splinting) due to reduced joint movement and soft tissue changes

Limited range of motion, pain, and stiffness in the affected joint and surrounding tissues after the removal of the cast

56
Q

Post-Fracture (Post-Fx)

A

Stiffness and reduced range of motion following a fracture due to immobilization

Joint stiffness, pain, and limited movement in the area surrounding the fracture site

57
Q

Post-Operative

A

due to inflammation, scar tissue formation, or immobilization

Reduced range of motion, swelling, and pain around the surgical site.

58
Q

Painful wrist:

A

CTS
DeQuervain’s tenosynovitis
CMC OA
RA

59
Q

Carpal Tunnel Syndrome (CTS)

A

Compression of the median nerve as it passes through the carpal tunnel in the wrist

Pain, numbness, and tingling in the thumb, index, middle, and part of the ring fingers

Symptoms are often worse at night and can be associated with weakness in hand grip and fine motor tasks

60
Q

De Quervain’s Tenosynovitis

A

Inflammation of the tendons and their sheaths on the radial side of the wrist, specifically the abductor pollicis longus and extensor pollicis brevis tendons

Pain and swelling at the base of the thumb and radial side of the wrist, often aggravated by gripping or pinching activities

positive Finkelstein’s test, where pain is elicited when the thumb is grasped and the wrist is ulnarly deviated, is commonly used for diagnosis

61
Q

Radio-Carpal Distraction facilitates:

A

general motion

62
Q

Radio carpal dorsal glide facilitates:

A

wrist flexion

typically performed with the wrist in a neutral or slight extension position

increases the space in the palmar aspect of the wrist joint

carpal bones to move more freely and accommodate the bending of the wrist forward

63
Q

Radio carpal volar/palmar glide facilitates:

A

wrist extension

64
Q

Loose pack position:

A

wrist in straight line through the radius and third metacarpal with slight ulnar deviation

increases the space in the dorsal aspect of the wrist joint

carpal bones to move more freely and accommodate the bending of the wrist backward

65
Q

Radio carpal ulnar glide facilitates:

A

wrist radial deviation

increase the range of motion for radial deviation (movement of the wrist toward the thumb side).

66
Q

Carpal Bone Accessory Motion Tests (AMT)

A

place your index fingers on the volar/palmar surface of the bone to be stabilized.

Place the overlapping thumbs on the dorsal surface of the bone to be manipulated. The rest of your fingers hold the patient’s hand so it is relaxed.

Always mobilize in the palmar direction using the thumbs

67
Q

To increase flexion, mobilize the ____

A

concave side (rolls and glides palmarly)

68
Q

To increase extension, mobilize the ___

A

convex side (the roll is dorsal, so the glide is palmar)

69
Q

To increase flexion: Place the stabilizing index fingers under the bone that is_____ Overlap the thumbs and place on the dorsal surface of the bone that is_____ The thumbs provide the manipulating force.

A

convex(on the volar/palmar surface)

concave.

70
Q

Stabilize Convex scaphoid, mobilize concave ____ and ____ in palmar direction

A

trapezium
trapezoid

71
Q

Stabilize Convex capitate, mobilize concave ___ in ____ direction

A

lunate
palmar

72
Q

Stabilize Convex hamate, mobilize concave ____ in palmar direction

A

triquetrum

73
Q

To increase extension: Place the stabilizing index fingers under the bone that is_____ Overlap the thumbs and place on the dorsal surface of the bone that is____ The thumbs provide the manipulating force.


A

concave(on the volar surface)

convex

74
Q

Stabilize concave trapezium and trapezoid mobilize convex ___ in palmar direction

A

scaphoid

75
Q

Stabilize concave lunate mobilize convex ___ in palmar direction

A

capitate

76
Q

Stabilize concave triquetrum, mobilize convex ___ in palmar direction

A

hammate

77
Q

Thumb Carpo-Metacarpal Joint (CMC)
Distraction:

A

Applying a pulling force away from the joint surfaces to separate the metacarpal and trapezium bones.

Purpose: Increases joint space and can help reduce joint stiffness and improve overall mobility.

78
Q

Thumb Carpo-Metacarpal Joint (CMC)
Ulnar Glide:

A

(Concave Metacarpal on Fixed Trapezium)

Applying a force to glide the metacarpal bone ulnarly (toward the little finger) relative to the fixed trapezium

Facilitates: Thumb radial abduction and flexion.

79
Q

Thumb Carpo-Metacarpal Joint (CMC)
Radial Glide:

A

(Concave Metacarpal on Fixed Trapezium)

Applying a force to glide the metacarpal bone radially (toward the thumb side) relative to the fixed trapezium

Facilitates: Thumb ulnar adduction and extension.

80
Q

Thumb Carpo-Metacarpal Joint (CMC)
Dorsal Glide:

A

(Convex Metacarpal on Fixed Trapezium)

Applying a force to glide the convex metacarpal bone dorsally (posteriorly) relative to the fixed trapezium

Facilitates: Thumb abduction + flexion.

81
Q

Thumb Carpo-Metacarpal Joint (CMC)
Palmar (Volar) Glide:

A

(Convex Metacarpal on Fixed Trapezium)

Applying a force to glide the convex metacarpal bone palmarly (anteriorly) relative to the fixed trapezium

Facilitates: Thumb adduction + extension.

82
Q

Thumb Carpo-Metacarpal Joint (CMC)
Resting position is neutral:

A

midway between flexion and extension and between abduction and adduction.

83
Q

MCP, PIP and IP joints
Resting position is in:

A

slight flexion for all joints

84
Q

MCP, PIP and IP joints
Distraction:

A

Applying a pulling force away from the joint surfaces to separate the proximal and distal bones

Purpose: Increases the joint space, which can help to alleviate joint stiffness and pain

85
Q

MCP, PIP and IP joints
Dorsal Glide:

A

Applying a force to glide the distal bone posteriorly (dorsally) relative to the proximal bone

Facilitates: Extension of the joint.

86
Q

MCP, PIP and IP joints
Volar (Palmar) Glide:

A

Applying a force to glide the distal bone anteriorly (volarly) relative to the proximal bone

Facilitates: Flexion of the joint.

87
Q

Convex-Proximal Bone, Concave-Distal Bone Dynamics: MCP Joint:

A

Convex Proximal Bone: Metacarpal head.

Concave Distal Bone: Proximal phalanx.

Dorsal Glide: Facilitates MCP joint extension.

Volar Glide: Facilitates MCP joint flexion.

88
Q

Convex-Proximal Bone, Concave-Distal Bone Dynamics: PIP Joint:

A

Convex Proximal Bone: Proximal phalanx.

Concave Distal Bone: Middle phalanx.

Dorsal Glide: Facilitates PIP joint extension.

Volar Glide: Facilitates PIP joint flexion.

89
Q

Convex-Proximal Bone, Concave-Distal Bone Dynamics: DIP Joint:

A

Convex Proximal Bone: Middle phalanx.

Concave Distal Bone: Distal phalanx.

Dorsal Glide: Facilitates DIP joint extension.

Volar Glide: Facilitates DIP joint flexion.

90
Q

Objective examination: Dexterity tests

A

Jebsen–Taylor Hand-Function Test

Nine-Hole Peg Test

Purdue Pegboard Test

91
Q

Jebsen–Taylor Hand-Function Test

A

evaluate a range of hand functions, including fine and gross motor skills

ability to perform daily tasks that require hand dexterity, speed, and coordination

Poor criterion and discriminant validity with MHQ

Small change for CTS; moderate change for RA, OA, Fx

92
Q

Nine-Hole Peg Test

A

measure dexterity and finger dexterity through timed peg placement and removal

assess fine motor skills, hand-eye coordination, and finger dexterity

used in neurorehabilitation and occupational therapy to measure changes in hand function

93
Q

Purdue Pegboard Test

A

evaluate both gross and fine motor dexterity, as well as hand-eye coordination

Part 1: Subjects place pegs into the holes using one hand at a time.

Part 2: Subjects assemble pegs, washers, and collars onto a pin.

evaluate manual dexterity, speed, and coordination

94
Q

Carpal Instability
Multi-link structure – Zigzag effect


A

Mobile proximal row “intercalated” between 2 rigid structures

Can get rotational collapse

Lunate most frequently dislocated- can dislocate dorsally (DISI scapholunate instability) or volarly (VISI-lunotriquetral instability)

95
Q

The wrist comprises eight carpal bones, which are organized into two rows: the proximal row ____ and the distal row _____

A

(scaphoid, lunate, triquetrum, and pisiform)

(trapezium, trapezoid, capitate, and hamate)

96
Q

Special tests – Instability

A

Scaphoid shear test
Scaphoid shift or Watson’s test
Lunotriquetral ballottement (Reagan’s) test
DRUJ instability / piano key test
Pivot shift test of midcarpal
Thumb ulnar collateral ligament test

97
Q

Scaphoid shear test

A

Testing for scapholunate instability

Lunate and scaphoid are then sheared in a dorsal/palmar directions

+ signs are laxity and reproduction of pt’s pain

98
Q

Key Concepts in Frontal Plane Carpal Stability

A

Ulnar Deviation: Movement of the wrist towards the ulnar side (little finger side).

Radial Deviation: Movement of the wrist towards the radial side (thumb side).

Scaphoid: A major bone in the proximal row that plays a critical role in wrist stability.

Lunate: Central carpal bone in the proximal row, significant in maintaining overall carpal alignment.

Trapezium and Trapezoid: Distal row bones that articulate with the metacarpals and contribute to stability during wrist movements.

99
Q

Scaphoid shift or Watson’s test

A

Patient sits with elbow resting on table and forearm in neutral

Patient sits with elbow resting on table and forearm in neutral

Radially deviate and slightly flex the patient’s wrist

+ if pain reproduced at dorsal aspect of wrist, and /or clunk is heard/felt, suggesting instability

Can be + in 1/3rd of individuals with no problem***

100
Q

Lunotriquetral ballottement (Reagan’s) test

A

Second most common instability (VISI- lunate tilts ventrally)

PT grasps the triquetrum between thumb and index finger of one hand and lunate with the thumb and index finger of the other hand

PT moves lunate in a palmar and dorsal direction

wrist moved into radial deviation, repeat w/wrist in ulnar deviation

+ test if reproduces pain, crepitus or excessive motion

101
Q

DRUJ instability / piano key test

A

Patient sits with both arms in pronation

PT stabilizes the patient’s arm with one hand so that PT’s index finger can push down on distal ulna (like in piano)

Results compared to the other side

Difference in mobility and with pain is + for distal radioulnar joint instability

102
Q

Pivot shift test of midcarpal

A

Patient is seated with elbow flexed at 90 deg and resting on firm surface and hand fully supinated

PT stabilizes the forearm with one hand and with the other hand takes the patient’s hand into full radial deviation with wrist in neutral

PT maintains position and patient’s hand is place in full ulnar deviation

+ if capitate shifts away from lunate indicating injury to anterior capsule and interosseous lig

+ test if at end ranges, proximal row “clunks” into place

103
Q

Thumb ulnar collateral ligament test

A

PT applies valgus stress to MCP joint/ UCL

Tested at 0 and 30 degrees MCP flexion

+ test is pain and extreme laxity (>15 degrees angulation as compared to uninvolved side- test opposite side first to get baseline)

Risk of Stener lesion- UCL entrapment under adductor pollicus apponeurosis

104
Q

testing at 0 degrees of MCP flexion assesses the ligament’s stability under :

A

the least amount of flexion, which puts the UCL under its maximum tension.

105
Q

testing at 30 degrees of MCP flexion assesses the UCL’s stability in :

A

a more functional and less strained position.

106
Q

Special tests – Instability

A

TFCC load test
Grip dynamometer

107
Q

TFCC load test

A

PT holds patient’s forearm with one hand and patient’s hand with the other hand

PT then axially loads and ulnarly deviates the wrist while moving it dorsally and palmarly or by rotating the forearm

If + there is pain, clicking, or crepitus in the area of TFCC

108
Q

Grip dynamometer

A

in neutral and in pronation

+ test- strength decreased and + pain when tested in the pronated position

109
Q

Special tests – Stiff, loose, painful – CMC OA

A

Grind test

Bunnell-Littler Test

110
Q

Grind test

A

PT holds the patient’s hand with one hand and grasps the patient’s thumb below the MCP with the other hand

PT applies axial compression and rotation to MCP

If with pain, test is + and indicates OA of MCP or metacarpotrapezial joint

111
Q

Key finding for CMC OA =

A

loss of retroposition

joint to move backward or toward the palm, especially during thumb opposition

= More flexed position of the thumb

112
Q

Special tests – Painful: tendons and muscles

A

Finkelstein test
Eichhoff’s test
WHAT test

high sensitivity, low specificity

113
Q

Finkelstein test

A

Examiner passively pulls the wrist and thumb into ulnar deviation and applies longitudinal traction

+ test indicates pain over APL and EPB tendons at the wrist

tenosynovitis of these tendons

Compare with the other side as this is likely to be + even with healthy individuals

114
Q

Eichhoff’s test

A

Patient makes a fist with thumb inside fingers

Examiner stabilizes the forearm and passively moves into ulnar deviation
+ test indicates pain over APL and EPB tendons at the wrist

Compare with the other side as this is likely to be + even with healthy individuals

115
Q

Wrist hyperabduction and abduction of the thumb (WHAT) test

A

Patient’s wrist is hyperflexed with the thumb abducted (actively moved radially) in full MCP and IP extension

Resistance is applied against the examiner’s index finger

+ test indicates pain over APL and EPB tendons at the wrist

116
Q

Special tests – Painful/paresthesias: nerve entrapment

A

Tinel’s sign at the wrist
> Median or ulnar nerve

Phalen’s / wrist flexion test

Froment’s sign

117
Q

Tinel’s sign at the wrist:
median

A

PT taps over the carpal tunnel (Median n.)

+ causes tingling into thumb, index finger, middle and lateral half of ring finger = Carpal tunnel syndrome

118
Q

Tinel’s sign at the wrist:
ulnar

A

PT taps over the Guyon’s tunnel (Ulnar n.)

+ causes tingling into 4th and 5th fingers
Tunnel of Guyon: space between hamate and pisiform

119
Q

Phalen’s / wrist flexion test

A

Test for CTS

PT flexes patient’s wrist maximally and holds for 45-60 sec by pushing wrists together

+ tingling over median n distribution ((thumb, index finger, middle finger, and half of the ring finger)

120
Q

Froment’s sign

A

Patient attempts to grasp a piece of paper between thumb and index finger

+ if terminal phalanx of the thumb flexes because of paralysis of the adductor pollicis

If + then ulnar nerve impairment

msk 3 midterm (2 decks)

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