Wrist/Hand Lab

Question 1

how do you assess distal radioulnar joint play?

Answer 1

stabilize ulna and mobilize radius, concave on convex
position: thumb towards ceiling in neutral rotation, hold radius in pinch grip while stabilizing ulna and move dorsal/volar
*alt: pt can also have fingertips up towards ceiling with elbow bent

Question 2

What direction of radioulnar mobilization improves pronation/supination?

Answer 2

dorsal glide: pronation
volar: supination

Question 3

radiocarpal joint assessment, proximal

Answer 3

stabilize radius/ulna and mobilize proximal row of carpals

Question 4

what direction of radiocarpal mobs improves flexion/extension?

Answer 4

dorsal: flexion
volar: extension

Question 5

what direction of intercarpal joint mob improves flexion/extension?

Answer 5

stabilize proximal row, mobilize distal row
dorsal: extension
volar: flexion

Question 6

what does carpometacarpal distraction improve?

Answer 6

all directions of motion

Question 7

what does 1st carpometacarpal glides improve?

Answer 7

medial: flexion/abduction
lateral: extension/adduction

Question 8

MCP dorsal glide improves

Answer 8

MCP extension

Question 9

MCP volar glide

Answer 9

MCP flexion

Question 10

ulnomeniscotriquetral dorsal glide test

Answer 10

purpose: triangular fibrocartilage complex (TFCC) pathology
position: seated, pronation
action: posterior force with thumb over ulna, index finger on anterior pisiform
positive: pain/laxity

Question 11

Watson test/scaphoid shift

Answer 11

purpose: scapholunate interosseous ligament instability
position: elbow supported w neutral rotation
action: stabilize radius, dorsal pressure to scaphoid, hold metacarpals on ulnar side; start ulnar dev and ext, move into radial dev/flexion
positive: pain, shift/clunk of scaphoid/familiar pain when pressure is removed

Question 12

piano key sign

Answer 12

purpose: distal radioulnar instability
position: pronation, support metacarpals
action: apply volar pressure on distal ulna with dorsal pressure on radius
positive: abn end feel, laxity, pain

Question 13

IP varus/valgus stress test

Answer 13

purpose: ligament sprain of IP joint
position: stabilize fingers and support
action: apply varus/valgus to PIP and DIP joints of digits
positive: pain or laxity

Question 14

Eischoff’s test

Answer 14

purpose: de quervain’s tenosynovitis in thumb
position: distal ulna at edge of table
action: pt makes a fist, passive ulnar deviation
positive: pain in only affected side

Question 15

finkelstein test

Answer 15

purpose: de quervain’s tenosynovitis in thumb
position: distal ulna at edge of table
action:
1. active ulnar deviation
2. passive ulnar deviation
3. passive thumb flexion
positive: pain in wrist, specifically at the tip of the styloid process

Question 16

WHAT test

Answer 16

wrist hyperflexion/abduction of the thumb test
purpose: de quervain’s tenosynovitis of the thumb
position:
action: pt hyperflexes wrist, extend thumb, abduct thumb
PT applies resistance until pt unable to resist
positive: wrist pain

Question 17

Phalen’s test

Answer 17

purpose: carpal tunnel/median nerve compression
position: max wrist flexion held with backs of hands together for 1 min
action:
positive: tingling/parasthesia in median n dist

Question 18

alternative phalen ‘s test for carpal tunnel

Answer 18

patient extends elbow to tension medial nerve, max wrist flexion and hold for 1 min
positive: N/T

Question 19

OK sign

Answer 19

purpose: identify anterior interosseous nerve
position: OK sign with thumb and index fingers together
action: hold paper between fingers and pull
positive: pt is unable to hold onto paper without bringing pulp of fingers together, flattening OK sign

Question 20

Froment sign

Answer 20

purpose: ulnar nerve palsy at adductor pollicis
position: pt holds paper with fla
action:
positive:

Question 21

two point discrimination test

Answer 21

test sensation on hand using paperclip on palm
normal is generally a little less than 6mm apart

Question 22

Tinel’s sign

Answer 22

purpose: carpal tunnel compression of median nerve
action: tap over median n in carpal tunnel
positive: tingling/paresthesia into hand median n distribution

Question 23

Wainner CPG for carpal tunnel

Answer 23

1. flick sign: pt gets relief by shaking hands
2. wrist ratio index> .67 ant/post measure to medial/lateral
3. Brigham and Women’s Carpal Tunnel Questionnaire
4. diminished sensation over top of thumb vs thenar eminence
5. age > 45 yrs

Question 24

modified Allen test

Answer 24

purpose: vascular compromise of hand
position: tight fist, compress ulnar and radial artery
action: pt opens hand, release one artery and note vascular filling time and color change
positive: filling time greater than 5-15 seconds

Question 25

squeeze test

Answer 25

purpose: RA
action: squeeze MCP joint
positive: pain