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ortho 3 > wrist and hand lab > Flashcards

wrist and hand lab Flashcards

1
Q

Distal radioulnar joint rule

  • how do we improve pronation
  • how to improve supination
A
  • Concave on convex
  • Pronation –> anterior glide
  • Supination –> radial glide
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2
Q 
radiocarpal and mid carpal joint rule?
how to incr:
-flexion
-extension
-radial deviation
-ulnar deviation
A
  • convex on concave
  • flexion = posterior glide
  • extension = anterior glide
  • radial deviation= ulnar glide
  • ulnar deviation= radial glide
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3
Q 
1st CMC joint rule?
How to incr: 
- flexion
- extension 
- Abduction
-Adduction
A
  • Concave on convex for flexion/extension
  • Convex on concave for abduction/adduction
  • flexion= ulnar glide
  • extension= radial glide
  • abduction= dorsal glide
  • adduction= volar glide
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4
Q

MCP/ IP joint rule?
How to incr:
- flexion
-extension

A
  • concave on convex
  • flexion= volar glide
  • extension= dorsal glide
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5
Q

Distal Radioulnar Anterior Glide

A

Purpose: Assess Radioulnar Range of Motion, Increase Pronation
: 1. If you are targeting the left distal radioulnar joint, place your left hand on table grasping and stabilizing the distal ulna
2. Grasp the distal radius with your right hand, placing your thenar eminence on the posterior portion of the distal radius
3. Keeping your elbows locked, stabilize the ulna in the left hand and gently glide the distal radius toward the table with your right hand
4. Assess for mobility and compare to contralateral side

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6
Q

Distal Radioulnar Posterior Radial glide

A

(↑supination
: 1. If you are targeting the left distal radioulnar joint, place your right hand on table grasping and stabilizing the distal ulna
2. Grasp the distal radius with your left hand, placing your thenar eminence on the anterior portion of the distal radius.
3. Keeping your elbows locked, stabilize the ulna in your right hand and gently glide the distal radius toward the table with your left hand

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7
Q

radiocarpal accessory traction

A

Purpose: Increase wrist flexion, extension, radial deviation, and ulnar deviation

  1. With your right hand grasp and stabilize the distal radioulnar joint creating skin slack 2. With your left hand grasp and stabilize the proximal row of carpals of the hand.
    3. At this point gently add a grade 3 traction by pulling your hands away from each other
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8
Q

radiocarpal Dorsal(post) glide

A

(↑flexion; most beneficial at MC) Purpose: To increase flexion and reduce pain.

  1. With the hand that is closest to the patient’s body stabilize the patient’s distal radius and ulna
  2. With the other hand hold on to the proximal carpal row, making sure to take up skin slack for patient comfort.
  3. A downward force is given to the first carpal row, Grades I-IV can be used.
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9
Q

radiocarpal volar (ant) glide

A

(↑extension; most beneficial at RC)
Purpose: To Increase wrist extension and reduce pain
1. With the hand that is closest to the patient’s body stabilize the patient’s distal radius and ulna
2. With the other hand hold on to the proximal carpal row, making sure to take up skin slack for patient comfort.
3. A downward force is given to the first carpal row; Grades I-IV can be used.

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10
Q

radiocarpal ulnar (medial) glide

A

(↑radial deviation)
Purpose: To increase radial deviation and reduce pain

  1. With the hand that is closest to the patient’s body stabilize the patient’s distal radius and ulna
  2. With the other hand hold on to the proximal carpal row, making sure to take up skin slack for patient comfort.
  3. A downward force in an ulnar direction is given to the first carpal row, Grades I-IV can be used.
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11
Q

radiocarpal radial (lateral) glide

A

Purpose: To increase ulnar deviation and reduce pain
1. With the hand that is closest to the patient’s body stabilize the patient’s distal radius
and ulna
2. With the other hand hold on to the proximal carpal row, making sure to take up skin slack for patient comfort.
3. A downward force in a radial direction is given to the first carpal row, Grades I-IV can be used.

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12
Q

midcarpal accessory mobility traction

A

Purpose: To aid in any wrist motion; traction to mobilize in any direction
. Stabilize patient’s wrist at proximal carpal row
2. Other hand bunches up tissue between mid-carpal row and proximal carpal row
3. Grab mid carpal row and apply grade 3 traction

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13
Q

midcarpal Dorsal (post) glide

A

Purpose: Increase wrist flexion

  1. Stabilize patient’s wrist at proximal carpal joint (in supination)
  2. Other hand bunches up tissue between mid carpal row and proximal carpal row
  3. Grab mid carpal row and apply grade 1 traction
  4. Mobilize midcarpal row dorsally (grade I, II, III, or IV)
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14
Q

midcarpal volar (anterior) glide

A

Purpose: Increase wrist extension

  1. Stabilize patient’s wrist at proximal carpal joint (in pronation)
  2. Other hand bunches up tissue between mid carpal row and proximal carpal row
  3. Grab mid carpal row and apply grade 1 traction
  4. Mobillize midcarpal row volarly (grade I, II, III, or IV)
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15
Q

midcarpal ulnar (medial) glide

A

(↑radial deviation)
Purpose: Increase wrist extension
1. Stabilize patient’s wrist at proximal carpal joint (in pronation)
2. Other hand bunches up tissue between mid carpal row and proximal carpal row
3. Grab mid carpal row and apply grade 1 traction
4. Mobillize midcarpal row volarly (grade I, II, III, or IV)

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16
Q

midcarpal radial (lateral) glide

A

(↑ulnar deviation)
Purpose: Increase wrist Ulnar deviation
1. Stabilize patient’s wrist at proximal carpal joint (wrist in 10 degrees supination)
2. Other hand bunches up tissue between mid carpal row and proximal carpal row
3. Grab mid carpal row and grade 1 traction
4. Mobilize midcarpal row radially, towards the ground (if arm is above head)(grade I, II, III, or IV)
5. If patient does not have enough shoulder ROM, PT can mob radially by pronating wrist with shoulder IR so thumb points down then mobilize down 6. If position #5 is also limited place forearm on table with wrist in 10 degrees supination and mob midcarpal row “up”/radially.

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17
Q

intercarpal glides

A

(checking for instability and lig laxity)
Purpose: To assess Carpal Mobility
1. Patient is asked to relax
2. Stabilize 1 carpal bone
3. Then ant/post shear to assess mobility
4. Compare sides

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18
Q

CMC ulnar glide

A

(concave; ↑thumb flexion A.K.A.- radial adduction)
Purpose: To increase thumb flexion
1. Apply a traction grade 1
2. Proximal hand  Stabilize Trapezium
3. Distal hand  Gently Mob the 1st MCP down or ulnarly towards the ulna to increase thumb flexion by the concave rule
4. Reassess for decreased pain and increased thumb flexion

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19
Q

CMC radial glide

A

(concave; ↑thumb extension A.K.A.- radial abduction)
Purpose: To increase thumb extension

  1. Apply a traction grade 1
  2. Proximal hand  Stabilize Trapezium
  3. Distal hand  Gently Mob the 1st MCP up or radially towards the ulna to increase thumb extension by the concave rule
  4. Reassess for decreased pain and increased thumb flexion
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20
Q

CMC dorsal glide

A

(convex; ↑thumb abduction A.K.A.- palmar abduction)
Purpose: To increase thumb abduction
1. Apply a traction grade 1
2. Proximal hand  Stabilize Trapezium
3. Distal hand  Gently Mob the 1st MCP dorsally or towards the palm to increase thumb abduction by the convex rule
4. Reassess for decreased pain and increased thumb abduction

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21
Q

CMC volar glide

A

(convex: ↑thumb adduction A.K.A.- palmar adduction)
Purpose: To increase thumb adduction
1. Apply a traction grade 1
2. Proximal hand  Stabilize Trapezium
3. Distal hand  Gently Mob the 1st MCP in a volar direction or towards the palm to increase thumb adduction by the convex rule
4. Reassess for decreased pain and increased thumb adduction ROM

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22
Q

MCP volar glides

A

Purpose: To increase flexion at the MCP joint and reduce pain

  1. With one hand stabilizing the patient’s metacarpal with a pinch grip 2. With the other hand hold on to the proximal phalange with a pinch grip, making sure to take up skin slack for patient comfort
  2. A downward force(Volar) toward the palm is given to the proximal phalange,
  3. Grades I-IV can be used
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23
Q

MCP dorsal glide

A

(↑ extension)
Purpose: To assess the Metacarpophalangeal joint in the dorsal direction. If necessary this technique can also be used as a form of treatment to mobilize and increase extension of the joint.

: 1. With one hand hold the patient’s hand so that the metacarpal is stabilized.

  1. With the other hand, grasp the proximal phalanx with a key grip
  2. Apply a traction grade 1 to the MCP joint, and move the proximal phalanx in the dorsal direction 4. Grades I-IV can be used
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24
Q

IP volar glides

A

(↑ flexion)
Purpose: To assess the Interphalangeal joint in the volar direction. If necessary this technique can also be used as a form of treatment to mobilize and increase flexion of the joint.

  1. Stabilize proximal phalanx with one hand
  2. Grab the distal phalanx with the other hand
  3. With both segments stabilized, apply a traction grade 1 to the IP joint
  4. Move the distal phalanx in the volar direction and assess mobility
  5. Apply Grade I-IV
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25
Q

IP dorsal glide

A

(↑ extension)
Purpose: To assess the Interphalangeal joint in the volar direction. If necessary this technique can also be used as a form of treatment to mobilize and increase flexion of the joint.

  1. Stabilize proximal phalanx with one hand
  2. Grab the distal phalanx with the other hand
  3. With both segments stabilized, apply a traction grade 1 to the IP joint
  4. Move the distal phalanx in the dorsal direction and assess mobility
  5. Apply Grade I-IV
26
Q
  1. Radioulnar ligament integrity test
A

Purpose: Assessment of the distal radioulnar ligament

  1. Grab the patients distal ulna using only your left thumb, index finger, and middle finger.
  2. With your right hand using the same grip grab the patient’s distal radius.
  3. With the patients wrist in neutral position assess the radioulnar excursion by creating a shear movement between the distal ulna and radius bones. There should only be about 4 to 5 mm of shear excursion.
  4. Move the patients forearm into full supination and reassess the shear excursion of the joint. There should be less excursion in an uncompromised joint.
  5. Now move the patient into full pronation and reassess the shear excursion of the joint. Again there should be less excursion in an uncompromised joint.
  6. (+) Positive test will occur when there is 4 to 5 mm or more of shear excursion of the distal radioulnar joint in full supination or full pronation indicating a compromised radioulnar ligament
27
Q
  1. Triquetrolunate test (ballottement test)
A

Purpose: Ruling in carpel instability
: 1. Examiner grasps the triquetrum between the thumb and second finger of one hand
2. With the other hand examiner grasps the lunate between the thumb and second finger
3. Examiner moves the lunate palmar and dorsal with respect to the triquetrum
4. (+) Positive test is laxity, crepitus, or reproduction of pain

28
Q
  1. Watson’s Instability
A

Purpose: Assessment of the integrity of the scapholunate ligament

: 1. Place patient hand into slight extension and ulnar deviation

  1. Find scaphoid off end of radius and stabilize with thumb and index finger
  2. With free hand passively move wrist inflexion and radial deviation
  3. Release scaphoid
  4. (+) Positive test is palpable/audible clunk or reproduction of pain
29
Q
  1. 1st MCP valgus Stress
A

Purpose: To test the integrity of the ulnar collateral ligament

  1. Stabilize patient’s hand with one hand
  2. Take the patient’s thumb into 15 degrees extension with other hand
  3. Once in extension apply a valgus stress to the metacarpalphalangeal joint of the thumb to stress the ulnar collateral ligament.
  4. Positive test is valgus movement > 30-35 degrees indicative of a complete tear of the ulnar collateral ligament and accessory collateral ligaments.
30
Q
  1. MCP Collateral ligament stress test
A

Purpose: To test the integrity of the MCP collateral ligaments

  1. Use one hand to stabilize the patient’s hand
  2. .Use the other hand to bring the MCP joint into extension and apply a varus and valgus stress by wiggling the finger medially and laterally.
  3. Compare the amount of movement present with the MCP joint in extension with flexion. Move the patient’s MCP joint into flexion and apply the same varus and valgus force.
  4. (+) Positive test is more motion in MCP extension than flexion. If the motion is the same or greater in flexion the collateral ligaments are likely to be involved.
31
Q
  1. IP Collateral ligament stress test
A

Purpose: To test the integrity of the IP collateral ligaments

  1. Stabilize patients hand and MCP with one hand
  2. With other hand move IP joint into flexion, apply varus and valgus stress to the joint and repeat with the IP joint in extension
  3. (+) Positive test is flexion and extension should be equally taut. A positive test is seen with unequal motion
32
Q
  1. Hoffman test
A

test (also test wrist clonus into extension)
Purpose: Upper motor neuron screening
1. Examiner supports patients hand with fingers relaxed in one hand
2. With their free hand the examiner flicks the tip of one finger
3. (+) Positive test is flexion or opposition of thumb and/or flexion of fingers

33
Q
  1. Ulnar Snuff Box
A

(ECU & FCU) (for Triquetrum fracture) Purpose: To assess for a potential triquetrum fracture.
: 1. Locate the ulnar styloid process, and palpate distal to that within the ulnar snuffbox.
2. (+) Positive test is tenderness to palpation, implicating a possible triquetrum fracture.

34
Q

Anatomical Snuff Box

A

(APL, EPB & EPL)
Purpose: To rule out scaphoid fracture
1. Locate anatomical snuff box and palpate within the snuff box.
2. (+) Positive test is tenderness to palpation, implicating a possible scaphoid fracture.

35
Q
  1. Carpal Tunnel Tinel
A

Purpose: Detecting carpal tunnel syndrome

  1. Supporting the patients hand with one hand tinel the carpal tunnel
  2. (+) Positive test is provocation of patient’s symptoms such as paresthesias related to carpal tunnel syndrome
36
Q
  1. Phalen’s Test
A

Purpose: Detecting carpal tunnel syndrome

  1. Ask patient to flex wrists and hold for 1 minute
  2. (+) Positive test is provocation of patient’s symptoms such as paresthesias related to carpal tunnel syndrome
37
Q
  1. Reverse Phalen’s
A

Purpose: Detecting carpal tunnel syndrome

  1. Ask patient to extend wrists and hold for 1 minute
  2. (+) Positive test is provocation of patient’s symptoms such as paresthesias related to carpal tunnel syndrome
38
Q
  1. Median Nerve Compression Test
A

Purpose: Detecting carpal tunnel syndrome

  1. Apply pressure to the carpel tunnel for one minute
  2. (+) Positive test is provocation of patient’s symptoms such as paresthesias related to carpal tunnel syndrome
39
Q
  1. Wrist Flexion Median Nerve Compression
A

Purpose: To screen out/rule in median nerve neuropathy
1. Apply an even constant pressure over the median nerve at the carpal tunnel 2. (+) Positive test is reproduction of symptoms along the median nerve distribution within 30 seconds

40
Q
  1. Flick Maneuver
A

Purpose: Detecting carpal tunnel syndrome
: 1. Patient vigorously shakes hands
2. (+) Positive test is resolution of paresthesia symptoms related with carpal tunnel syndrome

41
Q
  1. Closed Fist/Lumbrical Provocation Test
A

Purpose: Detect carpal tunnel syndrome from lumbrical excursion
: 1. Ask patient to make fist for 1 minute
2. (+) Positive test is reproduction of symptoms along distribution of the median nerve

42
Q
  1. Wrist Ratio Index
A

Purpose: Assessment for carpal tunnel

  1. With calipers measure mediolateral width, then measure anterior posterior width
  2. (+) Positive test is if wrist ratio is greater than 0.67
43
Q
  1. Thenar Atrophy
A

Purpose: Assessment for carpal tunnel

44
Q
  1. Reverse Froment’s
A

Purpose: To assess for median nerve lesion and if the innervation of flexor pollicis longus is compromised.

  1. Pt is asked to make a pincer grip with their thumb and index finger, tip to tip 2. The therapist places a piece of paper in the patients grip and asks the patient to grasp tightly
  2. The therapist attempts to pull the paper out of the pts grasp with moderate resistance.
  3. The patient’s resistance and ability to keep the pincer grasp is assessed 5. (+) Positive test is if fingers move into DIP/PIP extension (tear drop sign). Patient compensates movement with adductor pollicis (innervated by ulnar nerve)
45
Q
  1. Guyon’s Canal Tinel
A

Purpose: Detecting ulnar nerve paresthesias
. Supporting the patients hand with one hand tinel the Guyon’s tunnel
2. (+) Positive test is provocation of patient’s symptoms such as paresthesias related to 4th and 5th finger

46
Q

Froment’s Test

A

Purpose: To rule in/out an Ulnar nerve lesion

  1. Show patient the lateral key grip
  2. Have patient grip a piece of paper and test facilitation of the adductor pollicis by tugging on the piece of paper
  3. Instruct the patient to not let the piece of paper go
  4. (+) Positive test is recruitment of the flexor pollicis longus by going into thumb DIP flexion
47
Q
  1. Bunnell-Littler tightness
A

Purpose: To assess whether PIP motion is limited by capsular restriction or intrinsic muscle tightness

  1. Patient is asked to flex at their PIP joint, or the therapist passively does it for them, while keeping the MCP neutral.
  2. Range at this point is assessed and can be measured by the therapist.
  3. The MCP joint is fully flexed and the PIP joint is fully flexed.
  4. Range of the PIP at this point is assessed and can be measured.
  5. If PIP flexion range greater when MCP and DIP are fully flexed = Instrinsic muscle tightness
  6. If PIP flexion is same in both positions = Capsular restriction
48
Q
  1. CMC Grind test
A

Purpose: To assess the integrity of the CMC joint

  1. Flex the CMC joint, follow the metacarpal down to the CMC joint line
  2. Grind the joint by pushing the selected metacarpal in to the carpal bones.
  3. (+) Positive Test is reproduction of the patient’s symptoms, indicating over use and possible CMC arthritis
49
Q
  1. Trigger Finger Test
A

Purpose: To determine whether the patient has Trigger Finger of the flexor tendons during active or passive flexion/extension of digits. Trigger finger is a tenosynovitis of the digital flexor tendons, and is often associated with repetitive, forceful gripping of the hands and systemic diseases like gout.

  1. Patient is seated with forearm and dorsum of hand resting on towel on the table.
  2. Palpate the flexor tendon on the palm of the involved digit.
  3. Ask patient to open and close their hand, flexing at the MCP, PIP, and DIP joints.
  4. Have patient keep hand open, and therapist applies pressure on a tendon in the palmar surface of the hand.
  5. Keeping pressure on the tendon, ask patient to open and close their hand.
  6. If the nodes on the tendon are inflamed, there will be a catch and release, and lack of fluid movement when flexing and/or extending the fingers.
  7. (+) Positive test: Catch and release like a trigger on a gun. Patient gets “stuck” in flexion/extension before movement releases.
50
Q
  1. Figure of eight for wrist and hand swelling
A

Purpose: Assessment of wrist swelling

  1. Place zero mark of tape measure on end of ulnar styloid process
  2. Bring tape measure across ventral surface to end of radial styloid process
  3. Tape is then brought diagonally across dorsum of hand and over 5th MCP joint line
  4. Tape is then brought over ventral surface of MCP joints
  5. Tape is then wrapped diagonally across dorsum to meet start of tape
  6. X should be on dorsum of your hand.
51
Q
  1. Finkelstein’s Test
A

Purpose: Tenosynovitis screening

  1. Patient makes fist with thumb inside the fingers
  2. Examiner stabilizes the forearm and ulnarly deviates wrist
  3. (+) Positive test is reproduction of pain over the APL and EPB tendons at the wrist NOTE: Do this movement slowly
52
Q

Abductor Pollicis Longus and Extensor Pollicis Brevis resistance test

A

Purpose: Screening out tenosynovitis
: 1. Examiner resists thumb MCP joint extension
2. Examiner resists thumb palmer abduction 3. (+) Positive test is reproduction of symptoms.

53
Q
  1. Allen’s test
A

Purpose: To check the integrity of the blood supply to the hand
: 1. Patient rests arm on table and open and closes their hand ten times
2. Therapist compresses both radial and ulnar arteries at the anterior wrist 3. Therapist then releases pressure on one artery and checks refill time.
4. Therapist repeats the process, but this time releases the other artery
5. Compare with contralateral hand
6. (+) Positive Test is a refill time >2 seconds (refer back to M.D.)

54
Q
  1. TFCC load test
A

Purpose: Assessment of TFCC integrity

  1. Ask patient to push off on arm rests to suspend their body using only their hands
  2. (+) Positive test is reproduction of ulnar sided wrist pain
55
Q
  1. Dynamometer Grip Strength
A

Purpose: To objectively measure the amount of pain free grip strength a patient has or the amount of grip strength a patient has.

  1. Have patient grab dynamometer with gage facing you.
  2. Have patient grip the dynamometer either at full strength or pain free grip depending on which one you want.
  3. Repeat test 2 more times and record the best of 3
56
Q
  1. MWM (MC) Wrist Flexion
A

Purpose: To increase wrist flexion ROM and decrease reproduction of symptoms/pain

  1. Ask patient to actively perform wrist flexion, as therapist assesses ROM and pain
  2. Have patient come back to neutral, and therapist stabilizes proximal carpal row with one hand.
  3. Ask patient to flex their wrist and assess ROM and pain.
  4. Next, the therapist applies a lateral glide to wrist.
  5. While keeping on the lateral glide, ask patient to actively perform wrist flexion.
  6. Then, ask patient to over-press dorsum of their own hand into further wrist flexion.
  7. Therapist assesses ROM and the patient’s symptoms for reproduction of pain. 8. If this was not helpful in increasing ROM and decreasing pain, add a corrective glide (i.e., medial glide) and repeat the process. 9. Always assess ROM and pain when applying a different glide.
57
Q
  1. MWM (RC) Wrist Extension
A

Purpose: To increase wrist extension ROM and decrease reproduction of symptoms/pain

  1. Ask patient to actively perform wrist extension, as therapist assesses ROM and pain
  2. Have patient come back to neutral, and therapist stabilizes proximal carpal row with one hand.
  3. Ask patient to extend their wrist and assess ROM and pain.
  4. Next, the therapist applies a lateral glide to wrist.
  5. While keeping on the lateral glide, ask patient to actively perform wrist extension.
  6. Then, ask patient to over-press dorsum of their own hand into further wrist extension.
  7. Therapist assesses ROM and the patient’s symptoms for reproduction of pain. 8. If this was not helpful in increasing ROM and decreasing pain, add a corrective glide (i.e., medial glide) and repeat the process. 9. Always assess ROM and pain when applying a different glide.
58
Q
  1. MWM Interphalangeal Flexion
A

Purpose: To increase DIP or PIP flexion or extension ROM, and decrease reproduction of symptoms/pain in the digits.

  1. Have patient seated with dorsal forearm and hand resting on table
  2. Ask patient to actively perform finger flexion of the digit with pain/decreased ROM
  3. Have patient come back to neutral, and therapist stabilizes the proximal phalange
  4. Ask patient to flex finger and assess ROM and reproduction of pain.
  5. Next, the therapist applies a lateral glide to the distal phalange.
  6. Ask the patient to actively flex their finger as much as possible.
  7. While keeping the lateral glide, ask patient to over-press the dorsum of their digit into increased flexion.
  8. Therapist assesses ROM and symptoms for reproduction of pain.
  9. If this was unsuccessful in increasing ROM and decreasing pain, add a corrective glide (i.e., medial glide) and repeat the process.
  10. Always assess ROM and pain when applying a different glide.
59
Q
  1. Carpal Tunnel Spreading Mobilization
A

Purpose: Mobilize the carpal tunnel to loosen up the nerve
1. Patient is seated and therapist standing/seated in front of patient
2. Therapist uses the web space between their 4th and 5th fingers and hooks the patient’s 5th finger and thumb
3. Therapist spreads the palm and “primes it” several times
4. Add a spread to the carpal tunnel via applying pressure to the therapist’s 5th finger and thumb
5. Try to keep the wrist in neutral while performing the spread, and hold it for 30 seconds
6. Reassess reproduction of symptoms/pain with the median nerve
7. Perform treatment of 30 sec bouts of mobilizations with wrist in neutral
position

60
Q
  1. Median Nerve Slider
A

Purpose: Improve nerve mobility and normalize nerve sensitivity

  1. Patient is encouraged to perform the repetitive movement of elbow flexion and extension
  2. As the elbow extends, the head side bends to the treatment side
  3. As the elbow flexes, the head side bends to the contralateral side
61
Q

Clinical Prediction Rule Pediatric Wrist Fracture

A
  • Decreased grip strength by 20% compared to opposite side

* Distal radius point tenderness

ortho 3 (12 decks)

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