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Wrist/Hand Functional/Special Tests Flashcards

1
Q

DDx of Wrist/Hand Pain

A

-Tenosynnovitis
-Instability
-Fracture/Dislocation
-Neurovascular Injury
-Non- MSK

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2
Q

Wrist/Hand Observations

A

-Posture
-Willingness to move
-Dominant hand; functional status
-Muscle spasms, wasting
-Palmar/Dorsal sides of hands

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3
Q

Contraindications for Manual Therapy

A

-infection
-Fever
-Cancer
-Acute Circulatory Condition
-Open Wound
-Fracture
-Hematoma
-Advanced DM
-Hypersensitivity
-Abnormal Endfeel
-RA
-Cellulitis
-Constant, Severe pain
-Extensive radiation of pain
-Condition not evaluated

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4
Q

UQ Scan

A
  1. Vitals (HR and BP)
  2. CNs (optional)
  3. Observation: posture, plumb line, head, face, neck, mouth
  4. Gait: look for gross abnormalities
  5. Clear the spine
  6. UE ROM: All 6 w/ overpressure
  7. Dermatomes (C4-T2)
  8. Myotomes (C5-T1)
  9. DTR: bicep, brachioradialis, tricep
  10. UMN Testing: Hoffman’s, Babinski, Lhermitte
  11. Upper Limb Tension Testing (Median)
  12. Pulses (carotid, axillary, brachial, radial, ulnar) (optional)
  13. Thyroid (optional)
  14. Lymph Nodes (neck, and axilla) (optional)
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5
Q

Median Nerve ULTT 1

A
  1. Use elbow to depress scap
  2. Abduct
  3. Extend wrist and fingers
  4. ER
  5. Elbow extension
  6. Lat sidebending

+ Findings: differences btw sides, distant component, reproduction of s/s

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6
Q

Contraindications for Neurodynamic Mobilizations

A

-Recent repair
-Malignancy
-Active Inflammatory Disorders
-Acute Inflammatory Demyelinating Disorders

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7
Q

Radial Nerve ULTT 2

A
  1. Use hand to depress scap
  2. GH IR
  3. Flexion wrist and fingers
  4. Forearm pronation
  5. Elbow extension
  6. GH ABD
  7. Lat sidebending

+ Findings: differences btw sides, distant component, reproduction of s/s

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8
Q

Ulnar Nerve ULTT 3

A
  1. Use hand to depress scap
  2. Abduct
  3. GH ER
  4. Forearm pronation
  5. Extend wrist and fingers
  6. Elbow flexion
  7. Lat side bending

+ Findings: differences btw sides, distant component, reproduction of s/s

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9
Q

Wrist AROM Exam

A

-Flexion: 80-90 deg
-Extension: 70-90
-Rad Dev: 15
-Ulnar Dev: 30-45
-Supination: 85 deg
-Pronation: 75 deg

overpressure if pain-free
Resisted test in mid-range EVEN if painful

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10
Q

Finger AROM Exam

A

-Flx:
MCP: 80-90
PIP: 100-115
DIP: 80-90

-Ext:
MCP: 30-45
PIP: 0
DIP: 20

-ABD: 20-30
-ADD: 0

-Thumb Flx:
CMC: 45-50
MCP: 50-55
IP: 85-90

-Thumb Ext:
CMC: 20
MCP: 0
IP: 0-5

-Thumb ABD: 60-70
-Thumb ADD: 30

overpressure if pain-free
Resisted test in mid-range EVEN if painful

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11
Q

Wrist Resisted ROM

A

-hold for 5s

FCR/FCU: Flex + rad/ul dev
ECRL/ECRB: Ext + rdev
ECU: Ext + ul dev

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12
Q

Thumb Resisted ROM

A

-hold for 5s

APL/APB: Thumb abduction
Opponens Pollicis: Resist both sides of opp
FPL/FPB: Thumb flx
Adductor Pollicis: Thumb ADD
EPL/EPB: Thumb ext

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13
Q

Instrinsics Resisted ROM

A

-hold for 5s

Lumbricals: lumbrical grip
Palmar Interossei: PADs
Dorsal Interossei: DABs

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14
Q

Finger Resisted ROM

A

-hold for 5s

FDP: DIP flx
FDS: PIP Flx
EI/ED: Finger ext
Flexor Digit Minimi: pinky flx
Opponenns Digiti Minimi: Pinky opp

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15
Q

Palpation

A

Dorsal Surface:
-Snuff box
-scars
-scaphoid
-radial styloid
-ulnar styloid
-Bones

Palmar/Volar:
-pulses
-tendons
-arches

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16
Q

Wrist/Hand Hx: Subjective

A

-Pain (location, duration, quality and behavior/other pain)
-Neck/back issues
-Movement/functional limitiations
-MOI (traumatic/overuse/change in activities)
-Work
-Handedness
-Aggs/Eases
-Duration
-Age

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17
Q

Wrist/Hand Screening Questions

A

-Trauma
-OA or steroids or RA
-Head motions cause pain
-Movement of wrist
-Infection/wounds (Septic arthritis)
-Weakness

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18
Q

Pain with Resisted Testing: Wrist Ext

A

-wrist extensors
-radial nerve

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19
Q

Pain with Resisted Testing: Wrist Flx

A

-wrist flexors

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20
Q

Tendinopathy S/s

A

-pain w/ activities
-Hx of repetitive motions

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21
Q

Instability S/s

A

-pain after activities
-pain w/ prolonged static positions

22
Q

Wrist/Hand Hx: MOI

A

Trauma:
-fracture/dislocation
-strain/sprain
-growth plate injury
-bursitis
-neuro

Overuse:
-tendinopathy
-stress fracture
-growth plate
-neuro

Arthropatthies:
-OA/RA

23
Q

Functional ROM for Power Grips

A

-Hook
-Speherical
-Cylinder
-Fist

24
Q

Functional ROM for Percision Grips

A

-Pinch (pad to pad; tip to tip)
-5 Finger Pinch
-Tip Pinch
-Lateral Key Pinch
-3 Fingered Pinch

25
Hand Dynamometer
-measured in functional positions -10% differrences from R to L ->20% differences may be an issues -mean of 3 trials
26
Distal Radio-Ulnar Joint: Joint Play
-concave rad + convex ulna= same -OPP: 10 SUP Volar Glide (PRO): -book end grip; move radius Dorsal Glide (SUP): -book end grip; mvoe radius
27
Radio-Carpal Joint: Joint Play
-Convex carpals + Concave radius= opp Distraction (All movement): -Move carpals; hand distal to radius Palmar Glide (Ext) Dorsal Glide (Flx) Ulnar Glide (Radial dev) radial Glide (Ulnar Dev)
28
Mid-Carpal Joint: Joint Play
-Convex on Concave= opp Distraction (All movement): -Move carpals; hand distal to radius Palmar Glide (Ext) Dorsal Glide (Flx) Ulnar Glide (Radial dev) radial Glide (Ulnar Dev)
29
Carpo-Metacarpal (CMC) Joint: 2-5 Joint Play
2nd-5th Joints: Concave metacarpal on convex carpal= same Ant glide (FLX) Post Glide (EXT) Distraction (ALL)
30
Carpo-Metacarpal (CMC) Joint: Thumb Joint Play
Anterior/Posterior: Convex on concave= opposite Medial/Lateral: Concave on convex= same Ant glide (ADD) Post (ABD) Ulnar/Medial glide (FLX) Radial/Lateral glide (EXT) Distraction (ALL)
31
Metacarpo-Phalangeal (MCP): Joint Play
Concave on Convex= same Ant glide (FLX) Post glide (EXT) Ulnar/Medial glide (ADD) Radial/Lateral glide (ABD) Distraction (ALL)
32
PIP and DIP: Joint Play
Concave on Convex= same Ant glide (FLX) Post glide (EXT) Distraction (ALL)
33
Special Test for Tendon and Muscles
-Finkelstein Test
33
Special Test for Ligaments, Capsule, and Joint Stability
-Liagmentous instability of fingers -Thumb UCL Instability -Watson Shift Test -Ballotement Test -Murphy's Sign -Piano Key Test
34
Special Tests of Neurological Dysfunction
-Tinel's -Phalan's Test -Reverse Phalen’s Test -Fromment's Sign
35
Special Test for Circulation and Swelling
-Allen's Test
36
Ligamentous Instabilty of Fingers Test
1. Hold distal and pxovimal joints 2. Provide Valgus and varus stress 3. Test both sides *relative to middle finger*
37
Thumb UCL Instability Test
Gamekeeper's/Skier Thumb 1. Flex MCP to 30deg and apply VALGUS (ulnar) stress (+): excess ABD
38
Watson/Scaphoid Shift Test
-Scapho-lunate instability 1. Pt hand in pronation 2. PT graps radial side with thumb over scaphoid and other hand on ulnar side carpals 3. Start in ulnar deviation + ext 4. Move to radial dev + flex (+): subluxation or clunk over thumb w/ pain= tear of scapho-lunate ligament
39
Ballotement Test
-luno-triquetral Instability 1. Grasp triquetrum and lunate 2. move lunatee palmarly and dorsally w/ respect to triquetrum (+): laxity, crepitus or reproduction of pain= luno-triquetral ligament tear
40
Murphy's Sign
-lunate dislocation 1. Inspect dorsal of hand in fist 2. check if 3rd knuckle is level with the rest (+): 3rd knuckle same level= lunate dislocation
41
Piano Key Test
-TFCC tear 1. Press on ular styloid (+): reproduction of pain or laxity
42
Finkelstein Test
-De Quervain's 1. Make a fist enclosing thumb 2. Ulnar deviate slowly (+): pain over APL/EPB tendons
43
Tinel's Sign at Wrist
-carpal tunnel (median nerve) 1. Tap over carpal tunnel (+): N/T into thumb/index/middle/half of the ring finger; can determine most distal degeneration
44
Phalan's Test
-carpal tunnel -wrist flexion 1. Pt wrists in max FLX for 1 min (+): tingling in 1-3 finger and half of 4th
45
Reverse Phalen's Test
-carpal tunnel -wrist extension 1. Pt wrists into full EXT for 1 min (+): tingling in 1-3 finger and half of 4th
46
Fromment's Sign
-tests ulnar palsy -uses Adductor Policis 1. Try to grasp a piece of paper in lateral pinch grip 2. PT tries to pull it away (+): -Flexion at IP to hold on using FPL -Thumb hyperextends (Jeanne's Sign)
47
Allen Test
-if suspecting radial or ulnar artery deficencies 1. Open and close hand 5x quickly 2. Keep fist closed and PT pinches ulnar AND radial artery 3. Open hand and observe each when letting go of artery (+): Color returnns to hand in 6-10s (-): Pallor remains after10s = comprimised blood flow on released side
48
Order of Exam
1. Subjective 2. Observation of Hand 3. Scan if needed 4. Palation 5.ROM 6. Muscle 7. Joint Play 8. Special Tests
49
ROM Order
1. DRUJ 2. Radio-Carpal Joint 3. Mid-carpal Joint 4. Carpo-metacarpal Joint 5. Metacarpal-Phalangeal 6. IPs
50
Palpation Order
1. Radius 2. Ulnar styloid 3. Scaphoid, Lunate, Triquetrum, Pisiform (palmar side) 4. Trapezium, trapezoid, capitate, hamate 5. Metacarpals 6. IPs
51
1st CMC OA CPR
1. Hand pain or stiffness 2. Hard tissue enlargement of >2 joints AND 2nd/3rd DIPs and PIPS and 1st CMC 3. <3 swollen MCPs 4. Hard tissue enlargement of >2 DIPs 5. Deformity of >2 selected joints *>2 = greater than or equal to*

MSK (48 decks)

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