Foundations Of Pt Evaluation - Upper Extremity

Front 1

Cervical spine screen

Back 1

active flexion, extension, rotation, and lateral flexion with overpressure
stabilize at shoulder, resist on forehead, not jaw, special position with rotation

Front 2

shoulder joint screen

Back 2

active flexion, hyperextension, abduction, and IR and ER with overpressure
stabilize on scapula
internal - hand behind back
external - hand over behind head
block humerus and rotate more

Front 3

Elbow joint screen

Back 3

active flexion, extension, pronation, and supination with overpressure
good hand position

Front 4

wrist joint screen

Back 4

active flexion, extension, radial and ulnar deviation, pronation and supination

Front 5

Upper motor neuron reflexes for upper extremity - Hoffman's reflex

Back 5

Pt. sit w/ head neutral, flick nail of middle finger
positive test - flexion of interphalangeal joint of the thumb w/ or without flexion of index finger proximal or distal interphalangeal joints

suspect upper motor neuron lesion if multiple levels involved, or positive MOI, or 4+ reflexes

Front 6

DTR reflex response graded on what scale?

Back 6

4-point
Absent - 0
diminished - 1+
Normal - 2+
Hyperactive - 3+
Hypertonic/clonus - 4+

Front 7

Biceps reflex

Back 7

C5
support arm - relaxed
place thumb on insertion of biceps (radial tuberosity)
hit own thumb with pointy end of hammer

Front 8

Brachioradialis Reflex

Back 8

C6
support arm under wrist or grab by thumb and let arm dangle
relax
strike where brachioradialis becomes a tendon (>1/2 way down forearm)

Front 9

Triceps Reflex

Back 9

C7
support forearm OR bring elbow out and let forearm hang
hit above olecranon

Front 10

Sensation Testing

Back 10

1. light touch - cotton ball, cue tip
2. superficial pain (sharp-dull)
3. Hot/cold
4. Pressure (monofilament)
5. Vibration (tuning fork at distal locations)
6. Two-point discrimination

Front 11

C1 & 2
Myotomes, reflexes, dermatomes

Back 11

muscles that flex the neck
no reflex
C1 - top of head
C2 - posterior occipital region

Front 12

C3

Myotomes, reflexes, dermatomes

Back 12

muscles that side bend the neck
no reflex
derm - side of neck

Front 13

C4
Myotomes, reflexes, dermatomes

Back 13

Shoulder-shrug
no reflex
upper shoulder region just below neck line

Front 14

C5
Myotomes, reflexes, dermatomes

Back 14

Biceps (arms hooked in front of body) or deltoid
biceps reflex
lateral antecubital fossa

Front 15

C6
Myotomes, reflexes, dermatomes

Back 15

Biceps or wrist extensors (bend wrists up)
brachioradialis reflex
anterior-distal thumb

Front 16

C7
Myotomes, reflexes, dermatomes

Back 16

Triceps (opp of biceps)
triceps reflex
anterior-distal long finger

Front 17

C8
Myotomes, reflexes, dermatomes

Back 17

Thumb abduction or finger flexors
no reflex
anterior distal fifth finger

Front 18

T1
Myotomes, reflexes, dermatomes

Back 18

Finger abduction (interossei) (springy test!)
no reflex
medial aspect of the arm proximal to antecubital fossa

Front 19

Motions for Median Nerve upper limb tension test

Back 19

1. shoulder depression (hand on table)
2. shoulder abduction - to 90
3. Shoulder ER - let arm drop
4. Forearm supination
5. Wrist and finger extension
6. Elbow extension (creates big change)
7. Contra-lateral cervical sidebend

Ask when symptoms start and where they're felt, test different joints to make sure it's nerve rather than muscle tightness - move neck back and forth and note change

Front 20

Upper limb tension tests

Back 20

designed to place stress on neurological structures
always performed bilaterally, beginning with uninvolved limb
often produce symptoms in people w/o pathology
Findings positive when - production of "tension"/symptoms bilaterally asymmetrical or reproduce patient's familiar symptoms
Performed by adding components of movement in a given sequence
designed to "bias" (place stress on) various UE peripheral nerves
may also be + in pt. w/ cervical nerve root compression (radiculopathy)

Front 21

Radial Nerve Upper limb Tension Test motions

Back 21

1. shoulder depression
2. Elbow extension
3. shoulder and arm IR
4. Wrist and finger flexion
5. shoulder ABduction
6. Contra-lateral cervical sidebend

Front 22

Ulnar nerve upper limb tension test motions

Back 22

1. Shoulder depression
2. shoulder abduction
3. shoulder ER
4. Forearm pronation
5. Wrist and finger extension
6. elbow flexion
7. contralateral cervical sidebend

Front 23

Capsular pattern of shoulder

Back 23

ER>ABD>IR
pattern of limitation

Front 24

capsular pattern of elbow

Back 24

Flex>Ext

Front 25

capsular pattern of wrist

Back 25

~= limitation of flex and ext

Front 26

capsular pattern of fingers (MCP, IP)

Back 26

flex > Ext

Front 27

capsular pattern of thumb (CMC)

Back 27

ABD > Ext

Front 28

capsular pattern of thumb (IP)

Back 28

Flex > ext

Front 29

Shoulder assessment: postural alignment
saggital view considerations:

Back 29

assess shoulder height symmetry
scapula should rest flat against thorax between vertebrae T2 and T7
The vertebral border of scap should be ~3 inches from spine and parallel to it
The scapula should be rotated 30 degrees to frontal plane (scapular plane)
The humerus is in neutral rotation (antecubital crease faces forward & olecranon faces posterior)

Front 30

Shoulder assessment: postural alignment
frontal view considerations:

Back 30

The line of gravity should run through the external auditory meatus (ear) and humeral shaft
Assess alignment of the spine including degree of cervical, thoracic, and lumbar curves

Front 31

Palpation: anterior structures of shoulder

Back 31

SC joint
sternal heads of sternocleidomastoid
infraclavicular fossa
coracoid process of scapula (in fossa)
supraclavicular fossa
acromio-clavicular joint
greater tuberosity of the humerus
lesser tuberosity (more medial)
bicipital groove

Front 32

Palpation: posterior structures of shoulder

Back 32

Scapular borders (axillary and vertebral)
Root of spine of scapula (T3/T4 spinous process level)
Supraspinous fossa of scap
Infraspinous fossa
Acromion process and acromial angle
superior angle of scap
inferior angle of scap (T7 spinous process level)

Front 33

Shoulder exam: joint screening

Back 33

Cervical spine - active flexion, extension, rotation, and lateral flexion with overpressure
elbow joint - active flexion, extension, pronation, and supination with overpressure

Front 34

Shoulder ROM
Prior to measuring upper extremity ROM w/ goniometer,

Back 34

Prior to measuring upper extremity ROM w/ goniometer, active movement should be observed for the presence of deficits, pain, or abnormal movement

Front 35

Functional assessment of shoulder range of motion

Back 35

Hand behind back HBB
Hand behind neck (HBN)
Raise arm to the front (flexion plane)
Raise arms to the side (scaption plane)
Raise arms to the side (true abduction plane)

Front 36

Dynamic Alignment - to be observed during motion assessment
shoulder

Back 36

During active movement of upper extremity, scapula should also move appropriately (e.g. protraction and upward elevation) in order to allow full motion of glenohumeral joint

Front 37

Observations during shoulder flexion

Back 37

scapula shouldn't wing during shoulder flexion or return from flexion
scapulae should be observed to move symmetrically and smoothly during bilateral motion
(if not, "scapular disskinesis", serratus anterior - upward rotation, along thorax)

Front 38

observations during shoulder scaption/abduction

Back 38

scapula will typically upwardly rotate ~60 degrees with arm elevation, thus producing 2:1 ratio with GH motion (scapulothoracic rhythm)
scapula shouldn't wing during shoulder scaption or abduction or return from those
scapulae should be observed to move symmetrically and smoothly during bilateral motion

Front 39

Goniometric measurements of shoulder in supine

Back 39

Shoulder flexion
Shoulder abduction
(2 alternatively performed in standing or sitting)
Shoulder IR
Shoulder ER

Front 40

Goniometric measurements of shoulder in prone

Back 40

Shoulder Hyperextension
0-45
intra ICC = 0.94
Inter ICC = 0.27
Axis - head of humerus
Still - trunk
Movable - humerus (can use lateral epicondyle)

Front 41

Shoulder Flexion ROM

Back 41

0-180
Intra & inter: .98 & .89
Axis - head of humerus
Still - trunk
Movable - humerus (can use lateral epicondyle)
stay in frontal plane, not full elbow flexion
alt. in standing or sitting

Front 42

Shoulder Abduction ROM

Back 42

0-180
Intra & inter: .98 & .87
Axis: head of humerus
Stationary: parallel to trunk (may hover above)
Move: humeral midline
Stabilize, ER, frontal plane, don't push into pain!

Front 43

Shoulder internal rotation ROM

Back 43

0-70
intra & inter: .43 & .11
axis: long axis of H
Move: ulna
Stat: parrallel/perp to table
can slid so table supports humerus

Front 44

Shoulder External Rotation

Back 44

0-90
intra and inter: .32 &.06
document abnormalities

note: often do passive ROM in shoulder
support limb and move slowly to help them relax, practice using goniometer

Front 45

Assessment of Glenohumeral Joint Mobility (joint play)
Joint mobility testing

Back 45

Assesses accessory/arthrokinematic motion
considers integrity of joint capsule (hyper/hypo mobility)
Should be performed in open packed position
Is performed bilaterally (usually beginning with the uninvolved side)
Anterior glide, posterior glide, inferior glide

Front 46

Anterior glide of humerus

Back 46

patient in prone
open packed
can push directly down

Front 47

Posterior glide of humerus

Back 47

patient in supine
Relax arm
can stand "inside" or "outside"
No traction here! Want max normal mobility
Maybe stabilize under scapula
Be aware of angle - oblique to posterior/lateral, lean over w/ palm on humeral head
feel for end feel

Front 48

Inferior Glide of Humerus

Back 48

Stand above (patient in supine or sitting)
Arm below 90 degrees abduction
webspace just below acromion
use thigh for leverage (in supine)
use body weight

Front 49

Muscle flexibility - clavicular fibers of pec major

Back 49

maintain shoulder in er and elbow in slight flexion
Don't allow lumbar hyperextension
arm should rest on supporting surface and fall away from chest in a symmetrical manner

(horizontal abduction)

Front 50

Muscle flexibility - sternal fibers of pec major

Back 50

shoulder in ER and elbow in slight flexion
Pt. raise arms overhead at an angle in line w/ direction of sternal fibers
don't allow hyperextension of lumbar spine
arm should drop below supporting surface in symmetrical manner

Front 51

Muscle Flexibility - Pec Minor

Back 51

patient in supine, determine if scapula are anteriorly tilted by palpating the spines of the scapula, should be in contact with supporting surface and sit symmetrically
palpate along spine to root
might not be fully in contact with table

Front 52

Muscle flexibility - Latissiums Dorsi/Teres Major

Back 52

Don't allow hyperextension of lumbar spine
pt. raises arms overhead close to head (straight shoulder flexion). Arms should rest on supporting surface in a symmetrical fashion

Front 53

Muscle flexibility - Scapular mobility

Back 53

Testing for scapular hypo- or hyper mobility involves a subjective determination of how easy it is to manually move the scapula in each direction. Pt. should be positioned on their side facing the therapist.
For best movement and control:
place top hand anteriorly over acromion process
place lower arm under patient's arm
place lower hand on inferior angle of scap
use 2 key points of control (acromion and inferior angle) to provide leverage when moving the scapula

Front 54

Standard procedure for MMT

Back 54

1. position patient
2. apply stabilization
3. have pt perform full motion against gravity
4. observe & correct for substitutions
5. Apply resistance
6. Repeat if necessary

Front 55

MMT of shoulder in sitting

Back 55

upper trap and levator scap
shoulder abductors - middle deltoid
shoulder flexors - anterior delt
Serratus anterior (more sensitive than in supine)

maybe IR and ER, arm at side, stabilize elbow
30% difference in strength vs. prone. OK for resistive tests

Front 56

MMT of shoulder in prone

Back 56

lower trap
middle trap
rhomboids
latissimus dorsi
teres major
posterior delt
shoulder internal rotation
shoulder external rotation

Front 57

MMT of shoulder in supine

Back 57

Serratus anterior
clavicular portion of pec major
sternal portion of pec major
pec minor

Front 58

MMT - upper trap and levator scapula

Back 58

Shrug
resist bilaterally

Front 59

MMT - shoulder abductors

Back 59

mostly mid deltoid
arm ab 90 degrees
resist humerus
stabilize opposite shoulder
in sitting

Front 60

MMT - shoulder flexors (anterior delt)

Back 60

flex 90
resist distal humerus
stabilize opposite shoulder
in sitting

Front 61

MMT - serratus anterior

Back 61

arm flexed 120-130 degrees
hand on humerus pushes down and back (toward extension), hand on inferior angle pushes scap toward downward rotation and away from ribcage

Front 62

MMT - lower trapezius

Back 62

Abduct 130 degrees and ER (thumb to ceiling)
Resist at acromial angle
lift arm, stabilize opposite (stand there)
raise arm and shoulder blade

Front 63

MMT - middle trapezius

Back 63

arm ab 90, thumb up
lift arm and shoulder blade up
stabilize opp and resist at acromion

Front 64

MMT - rhomboids

Back 64

arm across back on sacrum
retract shoulder blade
resist and stabilize
can do w/ arm at side

Front 65

MMT - Latissiumus Dorsi

Back 65

IR and extend (thumb up)
Resist at elbow on humerus
w/ flexion

Front 66

MMT - Teres Major

Back 66

hand on low back, arm into extension and adduction
push toward flexion and abduction

Front 67

MMT - posterior deltoid

Back 67

hang arm down, bring elbow up, stabilize that scapula and resist humerus

Front 68

MMT - shoulder internal rotation

Back 68

shoulder ab 90, elbow bent 90
stand at hand side
full range AG, stabilize that scap and trunk (on back), resist at distal forearm

Front 69

MMT - shoulder internal rotation

Back 69

Switch to stand on other side (if just doing ER)
shoulder ab 90, elbow bent 90
stand at hand side
full range AG, stabilize that scap and trunk (on back), resist at distal forearm

Front 70

MMT - Serratus Anterior

Back 70

in supine
whole arm straight up to ceiling (punch)
resist from wrist, humerus, or elbow (bent)

Front 71

MMT - Clavicular poriton of pec major

Back 71

supine
pull toward horizontal abduction
stabilize opposite side

Front 72

MMT - sternal portion of pec major

Back 72

Supine
forearm rotated in across body, pull outward

Front 73

MMT - Pectoralis Minor

Back 73

Supine
Arm at side
Jutt shoulder forward, stabilize opposite, resist at anterior shoulder (usually not concerned with it being weak, mostly respiratory rehab)

Front 74

Special tests for Acromioclavicular Lesions

Back 74

Palpation of AC joint - tender.
Sensitivity - .96, Specificity - 0.10
So, if it's not tender, rule it out
Active Compression Test - O'Brian's Test

Cross Body Adduction Test

Front 75

Palpation of AC Joint
test for...
Process
sensitivity/specificity

Back 75

test for acromioclavicular lesion
Palpation of AC joint - tender.
Sensitivity - .96, Specificity - 0.10
So, if it's not tender, rule it out

Front 76

Active Compression Test - O'Brian's Test (O'Brien?)
test for...
Process
sensitivity/specificity

Back 76

O'Brian's
test for acromioclavicular lesion
pt. standing, shoulder in 90 flexion and 10 adduction
Thumb up (ER) first
Resist inferiorly directed force
then, thumb down
Positive if patient reports pain localized to the AC joint when resistance is applied with thumb down, and reduced and/or eliminated pain with thumb up
(may also be positive for labral tear, pain feels deep)
Sen- 1.0 Spec - 0.97
Good test! (though just based on one study)

Front 77

Cross Body Adduction Test

Back 77

Test for Acromioclavicular lesion
Examiner flexes pt.'s shoulder to 90 and passively horizontally adducts limb across body (test non-contractile tissues). + = reproduction of patient's symptoms
Sens - 0.77
Spec - 0.79
pretty good test

Front 78

Special Tests for Rotator Cuff Injuries/Tears

Back 78

Open/full can and Empty can test
Drop Arm Sign
Infraspinatus Muscle Test

Front 79

Open/full can and Empty can test

Back 79

For rotator cuff injuries/tears
tear or tendonitis of supraspinatus
Standing with arm in Scaption (90 flex and 30 horiz abd)
Thumb up = full can (push down)
Thumb Down = empty can (push down)
+ if more pain with IR
might do bilaterally if it doesn't produce the same pain as their symptoms

Front 80

Drop Arm Sign

Back 80

For rotator cuff injuries/tears
Fully elevate arm in scapular plane, then slowly reverse
+ if patient experiences pain on descent or if the arm drops suddenly

Front 81

Infraspinatus Muscle Test

Back 81

For rotator cuff injuries/tears
W/ arm resting in neutral, pt. flex elbow to 90 and resist medially directed force
Stabilize elbow
+ if 1. patient exhibits pain or weaknss when resistance is applied OR
2. Patient's arm is externally rotated passively but falls into internal rotation when released

Front 82

Tests for Subacromial Impingement Syndrome

Back 82

Neer's test
Kenedy-Hawkins Test
Painful Arc Sign

Front 83

Neer's test

Back 83

for subacromial impingement syndrome
seated or standing
Therapist stabilized scapula with one hand and forces patient's arm into maximal elevation with the other
+ if pain produced
May also be done in abduction or scaption planes depending on which movements cause pain

Need rotator cuff to help humerus glide down, have muscle, tendon, and bursa that can be impinged
Scapula posteriorly rotates, you stabilize and minimize that
Active motion, then overpressure
If they had pain during AROM tests, test in that motion

Front 84

Kennedy-Hawkins Test

Back 84

For subacromial impingement
Standing, PT elevates pt's arm to 90 with elbow flexed 90 and then forcefully internally rotates the arm
Make as passive as possible
Can start more horizontally abducted and move in
Can bring your arm underneath to shoulder for more support
+ if pain occurs with Internal Rotation

Front 85

Painful Arc Sign

Back 85

For subacromial impingement
patient standing, fully elevate arm in scapular plane (or abduction or flexion) and then slowly reverse. Positive if pt experiences pain between 60 and 120 of elevation
(for true painful arc, pain must be absent, come on between 60 and 120, and then subside at some point during full elevation

pt may shift around pain
muscles kick in once in a better posiiton
See this in functional ROM tests

Front 86

Test clusters for Rotator cuff pathology

Back 86

to predict full-thickness rotator cuff tear
Drop-arm sign, painful arc sign, & infraspinatus muscle test
If all three positive: +likelyhood ratio is 15.6
If all 3 negative: -LR is 0.16
If all 3 are positive and patient greater than 60 yrs old: +LR is 28.0
If 2 positive: +LR is 3.6

Front 87

Test cluster for subacromial impingement

Back 87

to identify possible subacromial impingement syndrome
Hawkins-Kennedy Impingement Sign, Painful Arc Sign, & Infraspinatus Muscle Test
If all 3 positive: +LR is 10.56
If all 3 negative: -LR is 0.17
If 2 of 3 are positive: +LR is 5.03

Front 88

Tests for Biceps Tendon Pathology

Back 88

Speeds Test
Lippman's Test

Front 89

Speed's Test

Back 89

for biceps tendon pathology
pt standing or sitting with arm in partial elevation and forearm supination
PT applies resistance against elevation
+ if pain produced

Front 90

Lippman's Test

Back 90

for biceps tendon pathology
Palpate biceps tendon in bicipital groove, and then create movement stresses by internally and externally rotating the shoulder
+ with reproduction of patient's symptoms in the area of biceps tendon
stand behind

Front 91

General test for Teres Minor (for rotator cuff injuries/tears?)

Back 91

active ROM AG, and Passive (ER), apply resistance in ER

Front 92

Special Tests for Glenohumeral Joint Instability (Dislocations, traumatic injury)

Back 92

Sulcus Sign
Apprehension/Relocation Test
Anterior/Posterior Drawer

Front 93

Sulcus Sign

Back 93

for GH joint instability
pt sitting, PT applies inferior force to elbow
If sulcus identified, measured by number of fingerbreadths (1/2, 3/4, sometimes 1 or more)
Stabilize scapula
Don't do with severe instability

Front 94

Apprehension/Relocation Test

Back 94

supine, PT passively abducts shoulder to 90 and slowly externally rotates the shoulder
+ if pt reports pain or is apprehensive to allow their shoulder to be moved into the test position
If positive, PT may apply posterior force on humerus. If that diminishes pain or apprehension, this is further evidence or confirmation of a positive test.
Used in suspected cases of anterior subluxation/dislocation

Anterior shoulder most prone to instability, most commonly dislocated in that position (this test is not for those people)
Maintain eye contact! You'll see before they say. Don't let go of posterior force too soon
He often doesn't keep rotating even with posterior force

Front 95

Anterior/Posterior Drawer

Back 95

test for GH joint instability
supine (posterior) or prone (anterior), humerus abducted to 90 in scapular plane and PT places one hand on (under) pt's elbow and the other on proximal humerus
Used to detect shoulder instability
SENS - 0.5-0.9
SPEC - 0.85 - 1.0
Detect shoulder instability

Front 96

Tests for Labral Tears

Back 96

For SLAP Lesions - Active Compression Test (O'Brien's test)
Bicepts Load Test II

A Bankhart lesion must be considered any time a anterior dislocation of the shoulder occurs)
Bankhart - 3-7 o'ckock on labrum
SLAP - tear runs from anterior to posterior between 10 and 2:00

Front 97

Active Compression Test (O'Brien's Test) - 2nd time around

Back 97

For Labral Tears (SLAP lesion)
shoulder in 90 flexion, 10 adduction
resist inferior force with thumb up and thumb down
+ for labral tear if pt reports pain and/or clicking deep in the glenohumeral joint (Not AC joint) occurring when resistance is applied with thumb pointing down and reduced or eliminated when resistance applied with thumb pointing up
SENS: 0.63-1.0
SPEC: 0.73-.98
(may be + in ppl with injury to AC joint or for whom pain is elicited during contraction of relevant muscles)

Front 98

Biceps Load Test II

Back 98

supine, examiner grasps pt's wrist with one hand and elbow w/ other
place shoulder in 120 abduction with max ER, 90 elbow flexion, and forearm supination
Perform elbow flexion against resistance
+ if increase in symptoms during resisted contraction
SENS: 0.90
SPEC: 0.97
Good test!

Front 99

SPecial TEsts for Thoracic Outlet Syndrome

Back 99

Pec minor can compress, also scalenes, clavicle, ribs

Halstead's Test
Adson's Test

Front 100

Halstead's Test

Back 100

Seated or standing with shoulder in slight abduction and head hyperextended and rotated to contralateral side, PT palpates radial pulse as downward traction force is applied to upper limb.
+ if replication of symptoms or radial pulse is diminished or absent
Detect thoracic outlet syndrome
Pulse sign can be positive w/o syndrome

Front 101

Adson's Test

Back 101

Pt seated or standing with shoulder extended and externally rotated and their head extended and rotated to the ipsilateral side
Pt. takes deep breath and holds while examiner stabilized patient's sholder and palpates radial pulse
+ if replication of symptoms or diminution or disappearance of radial pulse
Used to detect thoracic outlet syndrome, specifically compression of the neurovascular bundle secondary to a cervical rib or abnormality of scalene muscles

Front 102

Observation during elbow assessment

Back 102

postural exam as in shoulder
symmetry - muscle tone (atrophy/hypertrophy)
Alignment - carrying angle
Signs of inflammation

Front 103

Palpation of elbow: medial structures

Back 103

Medial epicondyle
Medial collateral ligament
Medial supracondylar line
Ulnar nerve/groove

Front 104

Palpation of elbow: posterior structures

Back 104

Olecranon process/bursa
triceps tendon
Ulnar border
Olecranon fossa

Front 105

Palpation of Elbow: lateral structures

Back 105

Lateral epicondyle
Lateral collateral ligament? not really palpable
Lateral supracondylar line
Radial head

Front 106

Palpation of elbow: anterior structures

Back 106

biceps tendon

maybe also find coranoid process?

Front 107

Measuring ROM, active versus passive

Back 107

Active should be determined first. If full and painless, PROM generally not indicated. If history of trauma, PROM at end of active movement may provide info about overall irritability of the joint. If either AROM or PROM is not WNL, measure with goniometer

Front 108

Elbow ROM in SUPINE

Back 108

Elbow flexion/extension
0-145
intra = .86-.99
Inter = .89-.96
Shaft of humerus
Shaft of ulna
Joint line? I assume for axis

Front 109

Elbow ROM in sitting

Back 109

Forearm pronation and supination

Front 110

Pronation ROM

Back 110

0-90
intra = .96-.99
Inter - .83-.86
sitting
lie goniometer arm across wrist, line other up with humerus
Or, have pt hold pencil/stick and line one arm up with that (esp. if deformed wrist)

Front 111

Triceps brachii muscle flexibility/length test

Back 111

flex elbow fully, attempt to flex shoulder so humerus is vertical with olecranon to the ceiling

Front 112

Biceps brachii muscle length/flexibility test

Back 112

Extend elbow and shoulder, watch for reduction in ROM

With shoulder hyperextended, bend elbow to see if that increases shoulder ROM

Front 113

MMT for elbow - sitting

Back 113

biceps brachii and brachialis
supinator
pronators

Front 114

MMT for elbow - prone

Back 114

triceps brachii
could do supinator and pronators?

Front 115

Biceps brachii and brachialis MMT

Back 115

slight shoulder flexion
full elbow flexion
they'll "slip" a bit at first, then able to hold

Front 116

Triceps Brachii MMT

Back 116

abduct 90 w/ forearm hanging off table
full extension
then back off a bit (flex slightly) and resist by pushing toward flexion

Front 117

Supinator MMT

Back 117

elbow at side, palm up
push toward pronation (use thenar eminence)
(could use "clam" grip with both hands)

Front 118

Pronators

Back 118

palm down
elbow at side
push toward supination (use thenar eminence or "clam" grip)

Front 119

Tinel's sign for cubital tunnel

Back 119

flex elbow ~30
tap 4-6 times over patient's ulnar nerve, just proximal to the cubital tunnel
+ if tingling sensation or replication of patient's symptoms occurs
to detect cubital tunnel syndrome
ulnar distribution of symptoms

Front 120

Varus stress test (elbow)

Back 120

supine
slight flexion with forearm supinated
PT - one hand on medial aspect of elbow joint (feel joint space) and other along radial forearm, mid-shaft or distal forearm
provide lateral (varus) force using elbow as fulcrum
+ if familiar pain or excess joint laxity
to detect stability of lateral collateral ligament

Front 121

Valgus stress test

Back 121

supine
slight flexion and forearm supinated
one hand on lateral aspect of elbow (feel joint space), other medially on mid or distal forearm
provide valgus (medial) force to elbow by pulling forearm away from body,using elbow as a fulcrum
+ if familiar pain or excess joint laxity
to detect stability of medial collateral ligament of elbow

Front 122

Observation during hand and wrist assesssment

Back 122

often requires complete postural inspection (why?)
number of digits/segments
resting position/"attitude" of hand
creases - digital, distal palmar crease, proximal palmar crease
Hypertrophy/atrophy
-thenar and hypo-thenar eminences
skin/nail texture, pallor, color
-callouses usually more developed on dominant hand
- skin color/pallor related to circulation

Front 123

Palpation of wrist

Back 123

radial styloid process
ulnar styloid process
Lister's tubercle (radius)
anatomical snuffbox

Front 124

Palpation of hand and fingers

Back 124

scaphoid/navicular
lunate
triquetrum
Pisiform
Trapezium
Trapezoid
Capitate
Hamate and hook
metacarpals

fingers:
MCP joints
IP joints

Front 125

Wrist flexion ROM

Back 125

0-90
axis - lateral edge of ulna (styloid)
stationary - lateral epicondyle of humerus
Moving - 5th metacarpal (not just hypothenar eminence)
intra - .96
inter - .90

Front 126

Wrist hyperextension ROM

Back 126

0-70
axis - lateral edge of ulna (styloid)
stationary - lateral epicondyle of humerus
Moving - 5th metacarpal (not just hypothenar eminence)
Intra - .96
inter - .85

Front 127

Wrist radial deviation ROM

Back 127

rest forearm on table, usually in pronation
0-25
capitate = axis
Stationary = long shaft of ulna
moveable = 3rd metacarpal (not fingers)
Intra - .91
Inter = .66

Front 128

ulnar deviation ROM

Back 128

rest forearm on table, usually in pronation
0-35
capitate = axis
Stationary = long shaft of ulna
moveable = 3rd metacarpal (not fingers)
Intra - .94
Inter - .83

Front 129

MCP flexion/hyperextension ROM

Back 129

typically 0-70 says handout (norm actually >90?)
Place goniometer over the top of the joints (not on the side)

Front 130

MCP Abduction ROm

Back 130

typical 0-20
stat - metacarpal
axis - MCP joint
Move - proximal phalanx

Front 131

PIP flexion/hyperextension ROM

Back 131

0-90
place goniometer over the top (not on side)
Intra - .97
Inter - .97

Front 132

DIP flexion/hyperextension

Back 132

0-80
lie it over the top

Front 133

CMC extension ROM

Back 133

thumb
0-70
Axis - base of 1st metacarpal
arms - 1st and 2nd metacarpal

if they can be like a boyscout, don't worry about flexion (hand position)

Front 134

CMC Abduction ROM

Back 134

0-60
Axis - base of 1st metacarpal
arms - 1st and 2nd metacarpal
neutral supination
in sagittal plane, technically

Front 135

Wrist flexor and finger flexor soft tissue/muscle flexibility

Back 135

keep elbow extended, with fingers and thumb relaxed
extend wrist without radial or ulnar deviation
wrist should be ableto extend through full range, fingers may flex
Do together w/ finger flexors:
Extend fingers, wrist should still extend through full range

Front 136

Wrist extensor and finger extensor soft tissue/muscle flexibility

Back 136

elbow extended
flex wrist w/o radial/ulnar deviation
should flex through full range
Then, flex fingers and see if full wrist flexion is maintained

Front 137

Dorsal/ventral glide of wrist

Back 137

seated
forearm in pronation
PT stabilizes distal forearm by grasping distal ulna and radius as close to joint space as possible
other hand grasps proximal row of carpal bones
applies slight distraction and ventral or dorsal force to the proximal row of carpal bones
test to determine gross carpal mobility as well as a method of increasing wrist extension or flexion

Front 138

Radial/ulnar glide of wrist

Back 138

pt seated by table, forearm in neutral pronation
stabilize distal forearm by grasping distal ulna and radius as close to joint as possible
other hand grasps proximal row of carpal bones
PT applies slight distraction and radial/ulnar deviation force to proximal row of carpal bones
test to determine gross carpal mobility as well as a method of increasing wrist radial or ulnar deviation

Front 139

Extensor carpi ulnaris MMT

Back 139

resist on base of 5th metacarpal
pull "down and in"

Front 140

Extensor carpi radialis longus and brevis MMT

Back 140

move hand up and over
resist 2nd metacarpal (reach inbetween thumb and pointer), close to base

Front 141

Flexor carpi ulnaris MMT

Back 141

stabilize to prevent pronation
resist at base of 5th

Front 142

Flexor carpi radialis MMT

Back 142

Resist at base of 2nd metacarpal, close to base
move hand into flexion and radial deviation and resist

Front 143

Extensor digitorum MMT

Back 143

curl fingers over, resist straightening of fingers (let them go all the way)
or, keep IPs flexed and resist and end of proximal phalanx
do together or separate - pinky and extensor indicis

Front 144

Flexor digitorum profundus MMT

Back 144

stabilize other joints and resist DIP flexion

Front 145

Flexor digitorum superficialis MMt

Back 145

concentrate on just flexing PIP (flick distal phalanges to see if they're relaxed)

Front 146

Dorsal interossei MMT

Back 146

Spread fingers wide
push together and see if they snap back quickly

Front 147

Palmar interossei MMT

Back 147

Hold fingers together, pull apart and see if they snap back quickly

Front 148

Lumbricals MMT

Back 148

tests DABs and PADs as well
hand over edge, stabilize MCP joints, pt resists you pushing straight fingers into flexion
or
make a roof and have them keep it while you try to extend MCP joints
if fingers start flexing, they're compensating

Front 149

Adductor pollicis MMT

Back 149

get fingers as close to CMC as possible
pull out toward abduction

Front 150

Abductor pollicis brevis MMt
also longus

Back 150

palm to ceiling, thumb straight up
push down at proximal phalanx

Front 151

Opponens Pollicis and opponens digiti minimi MMT

Back 151

Cup hand
reach around and attempt to spread them apart

Front 152

Flexor pollicis brevis MMT

Back 152

flexes MCP
stabilize 1st MC and resist proximal phalanx

Front 153

Flexor pollicis longus MMT

Back 153

"flick your bic"
DIP
stabilize PIP

Front 154

Extensor pollicis longus MMT

Back 154

resist proximal phalanx

Front 155

Extensor pollicis brevis MMT

Back 155

Stabilize MCP and resist distal phalanx

Front 156

Flexor Digiti minimi MMT

Back 156

flexes MCP, resist at proximal phalange
originates from pisiform

Front 157

Abductor digiti minimi

Back 157

resist at pip

Front 158

Strength testing in hand

Back 158

use grip strength as general assessment of forearm strength
-dynamometer
pinch grip testing
MMT in sitting

Front 159

tests for DeQuervain's syndrome

Back 159

tenosynovitis of the first extensor tunnel
Finklestein's test

Front 160

Finkelstein's test

Back 160

for dequervain's syndrom (tenosynovitis of 1st extensor tunnel)
make fist and enclose thumb in flexed finger
stabilize forearm while moving wrist into ulnar deviation
positive if pain over lateral wrist
Have patient do actively (could also perform passively, but be careful)
perform bilaterally and compare
don't diagnose just based on this (also observation, palpation)
1st tunnel - AbdPL and EPB

Front 161

Tests for carpal tunnel syndrome

Back 161

tinel's sign
Phalen's Test
Reverse Phalen's Test

Front 162

Tinel's sign for Carpal tunnel

Back 162

forearm in supination and wrist in neutral position
tap wrist over carpal tunnel 4-6 times
test positive if symptoms are replicated or tingling occurs in median nerve distribution
to detect CTS
put fascia on stretch, tap over crease and end of lifeline
rater agreement - 81%
sens = .56-.74
Spec = .80-.91
+LR = 2.8-8.22
-LR = .80-.29

Front 163

Phalen's test

Back 163

for carpal tunnel syndrome
flex wrists maximally (put backs of hands together)
hold 60 seconds
+ if symptoms replicated or tingling in median nerve distribution

Front 164

Reverse Phalen's test

Back 164

for carpal tunnel syndrome
extend wrists and put palms together (prayer position)
hold 60 seconds
+ if symptoms replicated or tingling in median nerve distribution
don't need to do if Phalen's was positive (or vice versa, no need to provoke more pain)

Front 165

Tests for fracture of scaphoid

Back 165

palpation - anatomical snuff box and scaphoid bone (exquisite pain)
axial loading of thumb

Front 166

Axial loading of thumb

Back 166

for fracture of scaphoid bone
passively abduct and extend involved thumb at MCP joint
using other hand to stabilize radius on uninvolved side, apply compressive load through first CMC joint
+ with pain
do with history of FOOSH