Wrist/Hand Lab Flashcards
how do you assess distal radioulnar joint play?
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
What direction of radioulnar mobilization improves pronation/supination?
dorsal glide: pronation
volar: supination
radiocarpal joint assessment, proximal
stabilize radius/ulna and mobilize proximal row of carpals
what direction of radiocarpal mobs improves flexion/extension?
dorsal: flexion
volar: extension
what direction of intercarpal joint mob improves flexion/extension?
stabilize proximal row, mobilize distal row
dorsal: extension
volar: flexion
what does carpometacarpal distraction improve?
all directions of motion
what does 1st carpometacarpal glides improve?
medial: flexion/abduction
lateral: extension/adduction
MCP dorsal glide improves
MCP extension
MCP volar glide
MCP flexion
ulnomeniscotriquetral dorsal glide test
purpose: triangular fibrocartilage complex (TFCC) pathology
position: seated, pronation
action: posterior force with thumb over ulna, index finger on anterior pisiform
positive: pain/laxity
Watson test/scaphoid shift
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
piano key sign
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
IP varus/valgus stress test
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
Eischoff’s test
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
finkelstein test
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
WHAT test
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
Phalen’s test
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
alternative phalen ‘s test for carpal tunnel
patient extends elbow to tension medial nerve, max wrist flexion and hold for 1 min
positive: N/T
OK sign
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
Froment sign
purpose: ulnar nerve palsy at adductor pollicis
position: pt holds paper with fla
action:
positive:
two point discrimination test
test sensation on hand using paperclip on palm
normal is generally a little less than 6mm apart
Tinel’s sign
purpose: carpal tunnel compression of median nerve
action: tap over median n in carpal tunnel
positive: tingling/paresthesia into hand median n distribution
Wainner CPG for carpal tunnel
- flick sign: pt gets relief by shaking hands
- wrist ratio index> .67 ant/post measure to medial/lateral
- Brigham and Women’s Carpal Tunnel Questionnaire
- diminished sensation over top of thumb vs thenar eminence
- age > 45 yrs
modified Allen test
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
