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What aggravating factors are normal for a pt with wrist problems
- -writing
- - occupation or sporting factors
- - WB through wrist
- - eating, holdinf full cup
- - brushing hair
- - turning on tap
- -hammering
- - unscrewing jar
- - shave
- - buttons
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Easing factors for a pt with wrist problems?
- - rest
- - supportig wrist
- - hanging hand down
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COndcut a physical examination of a pt with wrist problems
- - freedom of movement
- - swelling
- - deformity
- - mm wasting- nerve disorder
- - skin changes
- - arches- normal curves of level
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What would you palpate when examining a pt with wrist problems?
- - warmth
- - swelling
- - tenderness (exactly where it is)- jts, lig, tendons
- - boney bits:
- - radial/ ulnar styloid
- - lister's tubercle
- - jt lines
- - hook of hamate
- - scaphoid- in snuff box
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What area would you clear for a pt with wrist problems?
- - cervical spine- pt sitting- stretch and compress spine
- - shoulder- active range and OP- F, Abd, Ext
- - Elbow- active range and Op- F, E
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Perform some quick test on ur pt with wrist problems
- - Prayer position (DF)
- - reverse prayer position (PF)
- - clenched fist
- - open hand
- - fom history
- - weight bearing- sit on edge of bed pt push up
- -rapid movement
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Perform the appropraite active movement assessment on a pt with wrist problems
- - supine/ sitting
- - wrist f (80)/ E (70), RD (20)/ UD (60), pro (90)/ sup (90)- OP, add compression, rapid, cobine E/RD, F/UD)
- - thumb (CMC)- F, E, Add, Abd, opposition
- - Fingers (CMC)- HF, HE - horizontal flex/ ext (cup hand)
- - Fingers (MCP)- F, E, Add, Abd- lumbrical movements- ensure you stabilise the correct part of the jt
- - Fingers (IP)- F, E
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How do you actively differentiate where the pain is in the wrist with pro and sup?
- - take into supination, take off supination and push into supination- does the pain occur?
- -do the same for pronation
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How do u differentiate between what jts cause the pain in wrist flexion and ext?
- radiocarpal
- mid carpal
- block the appropriate jts
- Pt actively moves their wrist
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How do u differentiate between what jts cause the pain in wrist RD/ UD?
- radiocarpal
- midcarpal
- block where appropriate
- pt actively do it
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Static mm tests
- - as appropriate
- - relevant movement
- - appropriate area
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Neurological examination for the wrist
range difference tells you
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Where would you find the capitate?
Ext wrist-in dip- ant to there is the capitate
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What are the various grip strengths and what position will you put the pt in to assess?
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Identify where the bones are in the wrist and hand
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Perform the appropriate Accessory movements on the inferior radial ulnar jt
- - AP
- - PA
- - Long ceph (RD)
- - Long caud (UD)
- Compress R and , at limit sup, pro, mid position
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Conduct accessory movements on the Radiocarpal and midcarpal jt.
- - AP, PA
- - med/ lat glide- R- U
- - long caud, ceph- hand in neutral/ ulna deviate long caudad, radialdeviate- ceph
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What is the anatomical position for the wrist and hands?
- palms up- need to remember this for AP and PAs
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Perform accessory movements on the intercarpal jts
- - AP, PA- vary angle
- - HF/ HE- cupping????
- - 10 tests
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Perform the 10 tests on the intercarpal jts
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Perform accessory movements on the carpometacarpal jts
- - rot (1st CMC- grind test- rot with compression)
- -AP, PA
- - Long ceph/ caud
- - med, lateral glide
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Perform the appropriate accessory movements on the intermetacarpal jts
- cupping (HF)
- Flattening (HE)
- - local/ general, +/- compression
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Conduct appropriate accessory movements on MCP and IP jts
- - rot
- - AP, OA
- - Long caud/ ceph
- - Ad/Ab
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What are the special tests for the wrist and hand?
- - finkelstein's test (De quervains)
- - Phalen's test (carpal tunnel syndrome)
- - Tinel's test (carpal tunnel syndrome)
- - grind test (1st CMC jt pathology)
- - Thumb ulnar collateral ligament (skiers thumb)
- - Triangular fibrocartilage complex (TFCC)- supination/ lift
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Conduct the finkelstein's test
- - is used to detect stenosing tenosynovitis ofthe APL and EPB
- - pt forms a first where the thumbis tucked in
- - stablise the wrist in the mid position
- - then dviates the wrist to the other side
- Pain in lateral wrist and thumb.
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Conduct the phalen's test
- For carpal syndrome
- - pt in wrist and elbow flexion
- - test is poisitve if pt experiences numbness or tingling with 45 sec
- - can reproduce the ache in the wrist, thumb or forearm
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Conduct the tinel's test
- - used to help diagnose CTS
- - tap over the area of the median nerve on the palmar surface of the wrist
- - if it produces tingling in the distribution of the nerve- palm of the thumb, index, middle and half the ring finger: tip of the middle and index finger
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Conduct the grind test
- - 1st CMC jt (thumb)
- - will confirm arthritis- pt will experience severe pain
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Conduct the thumb ulnar collateral ligament special test
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Conduct the triangular fibrocartilage complex test
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What are the general principles for treating a wrist problem?
- - ?immobilise/ resting splint
- - reduce swelling
- - restor ROM- passiveand active
- - re-train strength and function
- - relieve pain
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Perform a passive accessory to treat someone with wrist problems
- - vary degress of compr/distraction
- - combine with physiological movements/ position
- - vary angle/ pressure
- - vary contact position
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Treat a pt with wrist problems with passive physiological movements
- - general
- - localised
- - combined movements or with acessory
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Your pt presents with wrist problems demonstrate the general treatmentsyou would do!
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What radiocarpal treatments would you conduct on a wrist
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What treatments would you perfrom on the midcarpal of the wrist?
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What treatments would you perform on the inf R/U jt of the wrist?
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What treatments would you perform on the CMC jts of the hands?
- E
- F
- (of the 1st CMC - F, E, Ab, Ad, opposition)
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What treatments would you do with intermetacarpal jt of the hand?
- HF
- HE
- generalised/ localised
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How would you treat the MCP jts of the hand?
- F
- E
- Ab
- Ad
- Generalised F, E, circumduction
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How would you treat the IP jts of the hands?
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