What aggravating factors are normal for a pt with wrist problems
- - occupation or sporting factors
- - WB through wrist
- - eating, holdinf full cup
- - brushing hair
- - turning on tap
- - unscrewing jar
- - shave
- - buttons
Easing factors for a pt with wrist problems?
- - rest
- - supportig wrist
- - hanging hand down
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
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
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
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
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
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
How do u differentiate between what jts cause the pain in wrist flexion and ext?
- mid carpal
- block the appropriate jts
- Pt actively moves their wrist
How do u differentiate between what jts cause the pain in wrist RD/ UD?
- block where appropriate
- pt actively do it
Static mm tests
- - as appropriate
- - relevant movement
- - appropriate area
Neurological examination for the wrist
range difference tells you
Where would you find the capitate?
Ext wrist-in dip- ant to there is the capitate
What are the various grip strengths and what position will you put the pt in to assess?
Identify where the bones are in the wrist and hand
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
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
What is the anatomical position for the wrist and hands?
- palms up- need to remember this for AP and PAs
Perform accessory movements on the intercarpal jts
- - AP, PA- vary angle
- - HF/ HE- cupping????
- - 10 tests
Perform the 10 tests on the intercarpal jts
Perform accessory movements on the carpometacarpal jts
- - rot (1st CMC- grind test- rot with compression)
- -AP, PA
- - Long ceph/ caud
- - med, lateral glide
Perform the appropriate accessory movements on the intermetacarpal jts
- cupping (HF)
- Flattening (HE)
- - local/ general, +/- compression
Conduct appropriate accessory movements on MCP and IP jts
- - rot
- - AP, OA
- - Long caud/ ceph
- - Ad/Ab
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
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.
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
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
Conduct the grind test
- - 1st CMC jt (thumb)
- - will confirm arthritis- pt will experience severe pain
Conduct the thumb ulnar collateral ligament special test
Conduct the triangular fibrocartilage complex test
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
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
Treat a pt with wrist problems with passive physiological movements
- - general
- - localised
- - combined movements or with acessory
Your pt presents with wrist problems demonstrate the general treatmentsyou would do!
What radiocarpal treatments would you conduct on a wrist
What treatments would you perfrom on the midcarpal of the wrist?
What treatments would you perform on the inf R/U jt of the wrist?
What treatments would you perform on the CMC jts of the hands?
- (of the 1st CMC - F, E, Ab, Ad, opposition)
What treatments would you do with intermetacarpal jt of the hand?
- generalised/ localised
How would you treat the MCP jts of the hand?
- Generalised F, E, circumduction
How would you treat the IP jts of the hands?