Wrist & Hand

Question 1

Wrist & Hand available Movement

@ Radiocarpal

Answer 1

Wrist:
FL
EX 
Radial Deviation
Ulnar Deviation

Question 2

Wrist & Hand available Movement

@ Distal Radioulnar

Answer 2

Pronation

Supination

Question 3

Wrist & Hand available Movement

@ Carpal joints

Answer 3

Finger
FL
EX

Question 4

Capsular Patterns for Wrist & Fingers

@ Radiocarpal

Answer 4

FL & EX equally limited

Question 5

Capsular Patterns for Wrist & Fingers

@ Distal Radioulnar

Answer 5

Pain @ extreme of Rotation

Question 6

4 Types of Finger & Hand Deformities

Answer 6

1. Swan Neck Deformity
2. Boutonniere Deformity
3. Ape Hand Deformity
4. Duputytren’s Contracture

Question 7

1. Swan Neck Deformity

Answer 7

FL of the MCP and DIPS with EX PIPS

** Rheumatoid Arthritis

Question 8

Boutonniere Deformity

Answer 8

EX of MCP & DIPs
FL of PIPs

***Rheumatoid Artheritis

Question 9

Ape Hand Deformity

Answer 9

Wasting of Thenar Eminence (Median N palsy)
Thumb falling back in line with fingers
Loss of Thumb Opposition

Question 10

Duputytren’s Contracture

Answer 10

Contracture of palmar fascia with FL of MCPs and PIPs

4th and 5th digits

Question 11

Rule out for Wrist and Hand

Answer 11

Elbow (All mvmnts with over pressure)

Fingers
→ Half Fist with Over pressure
→ Full Fist with Over pressure

Question 12

Finkelstein test

Answer 12

Test for deQuervain’s disease
Tensynovitis occurring in the first dorsal carpal tunnel affects
1. AB pollicis Longus
2. EX pollicis Brevis

Positive:

1. A sudden severe pain at the wrist
2. Pain shooting down into thumb and into mm bellies
3. Px seated and wrist in Neutral
4. 親指を残りの指でにぎる
5. “Any Pain?”
6. Ok- Ulnar deviation / AD wrist

Question 13

Phalen’s Test

Answer 13

Median nerve - Carpal tunnel Syndrome

Positive:
Tingling or parasthesia into thumb and first two and half fingers

** hold one minutes

Question 14

Reverse Phalan’s test

Answer 14

いただきまーす
Test for Carpal Tunnel Syndrome

Positive:
Tingling or parasthesia into thumb and first two and half fingers

*hold one minute

Question 15

Allen’s Test

Answer 15

Circulation in the hand by Ulnar and Radial Arteries

Positive:
If the palm does not react or flushes slowly,
Partially or completely occluded

1. 手は頭の上（両手）グーパーグーパー（2ー3回）
2. キツくこぶし（グー）を握る
3. セラピスト 親指でRadial artery, 人差し指でulnar arteryを押さえる
4. セラピスト押さえたまま、患者 手のひらを広げる。（パー）
5. 手のひら、紫色に変色
6. セラピスト 親指で押さえていた血管リリース （人差し指はそのまま）
   ＊＊循環が正常であれば、即手のひらの血色が戻る
   ＊＊＊ 同じ工程5までを繰り返し、つぎは人差し指をリリース

Question 16

Bundle-Littler Test

Answer 16

1. Tightness of the intrinsic mm of the hand
   (Lumbricals and Interossei)
2. Jt Capsule contracture
   (Inability of a finger to curl into the palm)

Positive:

1. Inability to FL the PIP from tight intrinsic hand muscles
2. Joint Capsule Contracture

1.Hold MCP slightly EX and try to FL a PIP
↓
Differentiate b/w two causes, continue to test by
1. Slightly FL the MCP(relaxing intrinsic mm)
2. Attempt to FL PIP

★ PIP now FL- restriction of intrinsic hand mm
★ PIP NOT FL - PIP jt capsule contracture

Question 17

Neurological Tests for Wrist and Hand

Answer 17

Peripheral nn patters

Nerve roots patterns (dermatome/ myotome)

Question 18

Tinel’s Sign at the Wrist

Answer 18

Compression or Inflammation of Median nerve

Tap at Carpal tunnel

Positive:
Tingling or parasthesia into thumb and first two and half fingers