1
Q
assessment for joint mobs (and the wrist joint mobs themselves) for the “true” wrist joint is done with palm how
A
palm down for all except for post glides it’s palm up
2
Q
radial glide would mean pushing towards
A
radial side
3
Q
skilled activity of the hand requires ___ degrees of wrist flexion and ___ degrees of wrist ext
A
10
30 -35
4
Q
resting position of wrist is
A
10 degrees flexion with slight ulnar deviation
5
Q
closed packed wrist is
A
extension and radial deviation
6
Q
for all joint mobs of true wrist joint, your stabalization is where
A
AT STYLOIDS
7
Q
post wrist glide helps with
A
flexion
8
Q
ant wrist glide helps with
A
ext
9
Q
radial glide of wrist helps with
A
ulnar dev
10
Q
ulnar glide of wrist helps with
A
radial dev
11
Q
all wrist mobs are done in palm down except
A
post is done palm up
12
Q
radial and ulnar glides of the wrist are special with what motion
A
cresent shape
13
Q
mid carpal joint mobs and assessment, which are palm up/down
A
for midcarpals, only post glide is palm up
14
Q
where do you stabalize for mid carpal joint play
A
distal to the styloids
15
Q
if there is an issue with wrist flexion, where will a lesion or malformity probably be found (which joint)
A
midcarpal
16
Q
post glide of mid carpals helps with
A
flexion
17
Q
ant glide of mid carpals helps with
A
ext
18
Q
if you mob the pisiform for ulnar entrapment at guyon, mob it in what direction
A
proximally
19
Q
what 2 muscles attach at pisiform
A
FCU
ABD DIG MINIMI
20
Q
what direction does lunate usually dislocate
A
ant or volarly
21
Q
the thumb CMC (or the trapezio MC joint) is a ___ joint
A
saddle
22
Q
all thumb CMC mobs are done with palm
A
up
23
Q
thumb CMC post glide helps with
A
abd
24
Q
thumb CMC ant glide helps with
A
adduction
25
thumb CMC radial glide helps with
ext
26
thumb CMC ulnar glide helps with
flexion
27
explain inter MC joint mobs
like we did for toes, wiggle webbing
28
what movements would increase arch
post 3
| ant 2, 4, 5
29
thumb mcp mobs are done palm
up
30
thumb mcp ant glide helps with
flexion
31
thumb mcp post glide helps with
ext
32
MCP of 2-5, mobs are done palm
up
33
MCP 2-5 post helps with
ext
34
MCP 2-5 ant glide helps with
flexion
35
MCP 2-5 radial glide helps with
abd for digit 2
| add for 4 and 5
36
MCP 2-5 ulnar glide helps with
add for digit 2
| abd for 4 and 5
37
IP post glides help with
ext
38
IP ant glides help with
flexion
39
so all CMC/IP are done
palm up
40
only specifics of palm up and palm down are done
wrist or carpals/midcarpals
41
px over radial styloid area with gripping activities or abd think what pathology
dequarvains
42
Insidious onset of numbness and tingling in 1st 3 fingers; may complain of worse pain at night...pathology
CTS
43
Paresthesias over dorsal aspect of ulnar border of hands and fingers 4-5...pathology
ulnar nerve compression at guyons
44
inability to extend MCP or IP joints.....pathologies
Dupuytren’s contracture, Trigger finger
45
palpable bony nodules on lateral and dorsal surfaces of DIPs (associated with OA)
Haberdans nodes (OA)
46
if the bony nodules are found on the PIP joints they are called
Bershards
47
list the arches of the wrist
long
transverse over MC
transverse over carpals
48
motor nerve to adductor pollicus
ulnar
49
first dorsal compartment tenderness, you need to rule out
dequarvains
50
what is full excursion
opposite of blocked measurement (allowing all joints to be in motion as you measure)
51
explain wrist length measurements (extensors)
ELBOW FLEXED FIRST THEN ELBOW EXTENDED AND YOU MEASURE WRIST FLEXION, IF SECOND IS SMALLER THEN THEY ARE TIGHT
extensors are short if wrist flexion with the elbow extended is less than wrist flexion with elbow flexed (short if second is less than first)
52
explain wrist length measurement for flexors
ELBOW FLEXED FIRST THEN ELBOW EXTENDED AND YOU MEASURE WRIST EXT. IF SECOND MEASUREMENT IS SMALLER THAN THE FIRST THEY ARE TIGHT.
if wrist extension with elbow extended is less than with elbow flexed they are tight (if second is smaller than first)
53
lateral pinch tests what muscle and nerve
adductor pollicis/ulnar
54
what do you watch for with fromonts or lateral pinch
dont let them flex the thumb
55
3 special tests for scaphoid fracture
snuff box tenderness
compression test
supination with resisitance
56
explain supination with resistance test
pt is trying to pronate while you are trying to pull them into supination
57
phalans and reverse phalans you hold for ___ sec
60
58
what are the 4 tests for carpal tunnel
phalans
reverse phalans
tinnels
compression
59
how long do you hold the compression test for for carpal tunnel
30 sec (therapist uses both of their thumbs)
60
what is the watsons/scaphoid shift test
you start with wrist extension and ulnar deviation as you apply pressure on the scaphoid then quickly radial deviate and wrist flex
61
dequarvains is usually what tendons
abductor pollicis longus and extensor pollicis brevis
62
what 3 muscles make the snuff box
abductor polli longus and ext polli brevis
| ext polli longus (one on more dorsal/top that is alone)
63
explain a pos bunnel littner test
you measure the PIP of finger with MCP in neutral first, then you put MCP in flexion and PIP flexed (measure PIP) and if the PIP moves into more flexion with the MCP flexed= tight intrinsic muscles
64
what is the cut off for "normal" for the volume test
10 mls
65
oblique retinacular lig helps with ___ but helps prevent __
helps with DIP ext but prevents hyper ext
66
explain how oblique retinaculum helps with extension
As PIP actively extends – it puts tension on oblique ret. Lig, which helps DIP ext
67
what is the TFCC
Fibrocartilage disc b/t distal ulna and carpals in medial wrist
Contains Dorsal and volar radio-ulnar ligaments
Ulnar-carpal ligaments
68
function of TFCC
Primary function is to enhance joint congruency and cushion against compressive forces
69
what muscle attaches to the TFCC
ECU
70
muscles connected to the extensor hood
ED
EDM
EI
71
structures that go through the carpal tunnel
4 FDP tendons, 4 FDS tendons, Median N, FPL tendon
72
funtional mvmts of wrist involve
extension, ulnar deviation
73
open packed of distal RU joint
10 degrees sup
74
where is the TFCC
btwn ulna and carpals
75
midcarpal joint consists of
some lovers try
76
radio carpal joint consists of
radius
tfcc
scaphoid
77
MCPs resting position (other than thumb)
slight flexion
78
what goes through the carpal tunnel
median N
FDS
FDP
FPL
then on top is the palmaris longus
79
TFCC is on what side of wrist
medial
80
only extrinsic forearm muscle to insert on a carpal bone
FCU
81
tenodesis is what
floppy wrist makes motions
82
tunnel of guyon is btwn
pisiform and hook of hammate
83
serves as passage for ulnar N and ulnar A to get into hand
tunnel of guyon
84
3 common deformaties seen in hands of pts with RA
boutoneirres
ulnar drift
swan
85
to tx RA, what always is done
active and isometric ex for all motions
86
ulnar drift (with RA) occurs bc of
damage to collateral lig and extensors
87
with ulnar drift, there can be up to ___ degrees of lateral shift at the mcp
45 of mcp
88
boutoneiires
flexion of PIP ext of DIP
89
bouton deformity is dt what
damage to the slip
| common ext tendon that inserts on the base of the middle phalanx is damaged
90
boutonieres results in faulty
lateral bands in the extensor mech
| lateral bands cause hyper ext of dip
91
if there is 30 degrees of ext lag at the PIP suspect
boutonieres
92
how to splint for boutoneires
just do the PIP in ext and keep others free
93
with boutonieres, the lateral bands drift
forward
94
with swan neck deformity, the lateral bands drift
dorsally
95
Destruction of oblique retinacular ligament of the extensor mechanism leads to posterior displacement of the lateral bands
swan neck deformity
96
what is swan neck deformity
ext of pip
| flexion of dip
97
FDP flexes
distal
98
FDS flexes
proximal
99
Medial wrist pain distal to the ulna, increased with end-range forearm pronation/supination and forced gripping
Painful click during wrist motions
Tenderness localized to distal to ulnar head
Pain with ulnar (compression) and radial deviation (stretch)
TFCC
100
TFCC has
clicking popping
101
with TFCC you want to avoid what motions
pro and sup
102
TFCC movement dx (one of 2)
wrist flexiion with pronation
| wrist ext with pronation
103
OA of hand is usually where
usually 1st CMC
104
should you always trust plain film imaging if you suspect scaphoid fx
no - need a bone scan
105
nodules in palmar hand
Higher incidence alcoholic, diabetic, epileptic, tobacco
Inability to straighten fingers, primarily 4th and 5th (cannot even PROM extend them)
dupytren contracture
106
pain at ulnar side of 1st mcp (in the webspace) joint look into
game keepers thumb or UCL sprain
107
tenosynovitis is
inflammation of the sheath (have had tendoitis for a period and it's getting worse)
108
dull ache radial side
Local swelling and tenderness in region radial styloid
can creak or have palpable lumpy feel
dequarvains
109
with trigger finger, what can't they do
you can PROM but they cannot AROM
110
what is trigger finger
tendons get caught in the sheaths
111
tendon gliding exersion exercises progression
Straight hand
Hook hand – greatest excursion between FDP and FDS
Full fist – full excursion FDP
Flat fist – full excursion FDS
112
traumatic disruption of the terminal tendon (DIP ext)
| jammed
mallet finger
113
mallet finger can be ____ moved
passively (they just cant AROM)
114
CTS sx are usually worse
at night
115
claw hand (median N) effects what muscles
lumbricals (they arent working so the PIPs are in flexed contracture)
116
ape hand is due to
median nerve palsy
117
describe ape hand
Thumb doesn’t abduct/oppose bc you lose thenar muscle ability from median nerve
118
wrist drop is due to ___ nerve
radial
119
Compression of the superficial sensory radial nerve (between ECRL and brachioradialis tendons)
Pain, paresthesias, numbness on radial aspects of hand and wrist
Whartonburg syndrome
120
claw hand for ulnar nerve effects which muscles
lumbricals
121
```
past trauma
hyperalgesia
edema
skin changes
all sound like
```
chronic regional px syndrome
or
reflex sympathetic dystrophy
122
colles fx is a radial fx that displaces
post
123
smith fx is a radial fx that displaces
ant
124
boxers fx is of the
5th metacarpal (most common MC fx)
125
Treat all wrist pain with swelling and pain in snuffbox as _____ until proven otherwise
scaphoid fx
126
lunate usually disclocates
palmarly or ant
127
dequarvains usually has
crepitus
128
OA vs RA
OA is in one joint only
| RA multiple joints both sides
129
hook grip nerves
median and ulnar
130
power grip nerves
median and ulnar
131
lateral pinch uses what muscle and nerve
adductor poll
| ulnar nerve
132
precision pinch is what n
median
133
cylindrical grip nerves
med
ulnar
rad
134
numbness and tingling in palmar of hand think
CTS
135
medial wrist px distal to the ulna, think
TFCC
136
problems Writing, typing, using scissors, grasping objects
OA
| RA
137
inability to flex fingers/thumb or make a fist is what mvmt dx
insufficient flexion
138
list the hand/wrist mvmt dx
insufficient flexion (finger or thumb)
insufficient ext (finger or thumb)
insufficient abd or opp of thumb
thumb cmc hypermobility
139
explain thumb cmc hypermobility syndrome
px occurs at cmc but all thumb joints are effected
| decreased pinch ocurs
140
big difference btwn whartonburg and dequarvain
whartonburg is sensory only
| dequarvain has both sensory and motor
141
CTS mvmt dx
insufficient flexion
142
need to do imaging
ok
143
wrist joint (RC) and mid carpal joint play is
same
144
what links the PIP and DIP motions
oblique lig
145
the ext retinaculum and hood involve what muscles
ED
EI
EDM
then lumbricals and interossei
146
how to immobilize if central slip is damaged
they end up with boutoniers, so you extend the pip and leave the others alone
147
which hand pathology uses metal rings to correct
swan
148
explain physiology of swan vs boutoneir
bouoneirs - damage to the slip pulls lat bands ant
| swan -damage to the obliqe lig pulls the bands post
149
FCU or abd dig minimi issues (motor) would make you think
ulnar nerve entrapment at guyons
150
cant extend distal phalange
mallet
151
how does the oblique ret lig help with extension of DIP
As PIP actively extends – it puts tension on oblique ret. Lig, which helps DIP ext
152
claw hand effects what muscles
lumbricals (ulnar or median)
153
wrist drop would be dt what
radial nerve issue
154
when doing mobs for fingers or thumbs, palm is
palm up
155
when doing mob assessment for wrist or mid carpals, their position is
all are palm down except post is palm up
MSK
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