Prac Viva

  1. What are the kind of things you will be asking in the pt history?
    • - mechanism of injury- fall on an outstretched arm, catching ball, what tissue is on stretch
    • - surgery- post op protocol
    • - occupation, sport- type of grip, what they need to be able to do
    • - Carefully map area of pain
    • - Peripheral nerve symptoms
    • - Night pain/ paraesthesia
    • - any inflammatory indications
    • Area of pain- any PPN or numbness
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  2. 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
  3. Easing factors for a pt with wrist problems?
    • - rest
    • - supportig wrist
    • - hanging hand down
  4. 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
  5. 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
  6. 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
  7. 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
  8. 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
  9. PPMS
    as appropriate
  10. 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
  11. 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
  12. How do u differentiate between what jts cause the pain in wrist RD/ UD?
    • radiocarpal
    • midcarpal
    • block where appropriate
    • pt actively do it
  13. Static mm tests
    • - as appropriate
    • - relevant movement
    • - appropriate area
  14. Neurological examination for the wrist
    range difference tells you
  15. Where would you find the capitate?
    Ext wrist-in dip- ant to there is the capitate
  16. What are the various grip strengths and what position will you put the pt in to assess?
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  17. Identify where the bones are in the wrist and hand
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  18. 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
  19. 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
  20. What is the anatomical position for the wrist and hands?
    - palms up- need to remember this for AP and PAs
  21. Perform accessory movements on the intercarpal jts
    • - AP, PA- vary angle
    • - HF/ HE- cupping????
    • - 10 tests
  22. Perform the 10 tests on the intercarpal jts
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  23. Perform accessory movements on the carpometacarpal jts
    • - rot (1st CMC- grind test- rot with compression)
    • -AP, PA
    • - Long ceph/ caud
    • - med, lateral glide
  24. Perform the appropriate accessory movements on the intermetacarpal jts
    • cupping (HF)
    • Flattening (HE)
    • - local/ general, +/- compression
  25. Conduct appropriate accessory movements on MCP and IP jts
    • - rot
    • - AP, OA
    • - Long caud/ ceph
    • - Ad/Ab
  26. 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
  27. 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.
  28. 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
  29. 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
  30. Conduct the grind test
    • - 1st CMC jt (thumb)
    • - will confirm arthritis- pt will experience severe pain
  31. Conduct the thumb ulnar collateral ligament special test
  32. Conduct the triangular fibrocartilage complex test
  33. 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
  34. 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
  35. Treat a pt with wrist problems with passive physiological movements
    • - general
    • - localised
    • - combined movements or with acessory
  36. Your pt presents with wrist problems demonstrate the general treatmentsyou would do!
    • - F
    • - E
    • - RD
    • - UD
  37. What radiocarpal treatments would you conduct on a wrist
    • F
    • E
    • Sup
    • Pro
  38. What treatments would you perfrom on the midcarpal of the wrist?
    • F
    • E
    • HF
    • HE
  39. What treatments would you perform on the inf R/U jt of the wrist?
    • sup
    • pro
    • and compression
  40. What treatments would you perform on the CMC jts of the hands?
    • E
    • F
    • (of the 1st CMC - F, E, Ab, Ad, opposition)
  41. What treatments would you do with intermetacarpal jt of the hand?
    • HF
    • HE
    • generalised/ localised
  42. How would you treat the MCP jts of the hand?
    • F
    • E
    • Ab
    • Ad
    • Generalised F, E, circumduction
  43. How would you treat the IP jts of the hands?
    • F
    • E
    • Ab
    • Ad
Author
jessiekate22
ID
154319
Card Set
Prac Viva
Description
Notes
Updated