References:
- Norkin, C., White, D. (2009). Measurement of Joint Motion. A Guide to Goniometry.
- Konin, J., Wiksten, D., Iser, J., Brader, H. (2006). Special Tests for Orthopedic Examination. 3rd Edition
- Prentice, W.E. (2009). Arnheim’s Principles of Athletic Training (13th ed.). New York, NY: Mc-Graw-Hill.
- Starkey, C., Brown S., Ryan J. (2010). Examination of Orthopedic and Athletic Injuries. 3rd Edition
- Starkey, C. & Ryan, J. (2002). Evaluation of Orthopedic and Athletic Injuries (2nd ed.). Philadelphis, PA: F.A. Davis Company.
Answers
- 1 & 2. Some important things to consider while
performing this evaluation are
- The position of the wrist. You want to splint in the position the injury
is in so you don’t cause anymore damage.
- Location of any discoloration or swelling.
- Level of pain the athlete is experiencing.
- If the athlete heard any audibles
- Signs of shock.
- 3. What is a way to remember the four flexor muscles of the wrist?
- Place your thenar eminence of your opposite hand on your medial epicondyle. Your thumb, pointer finger, middle finger and ring finger will be in order as follows:
- Pronator Teres
Palmaris Longus
Flexor Carpi Ulnaris
- 4. What structure does the scaphoid support?
- The anatomical snuff box
- 5. What is another name for the scaphoid?
- Navicular
- 6. What is a saying to remember the eight carpal bones?
- Some Lovers Try Positions That They Can't Handle
- There are many saying out there and you can make up your own but, here is one option.
- 7. ROM: Wrist Flexion:
- Center the fulcrum on the lateral aspect of the wrist over the triquetrum.
- Align proximal arm with the lateral mid-line of the ulna, using the olecranon and ulnar styloid processes.
- Align the distal arm with the lateral mid-line of the fifth metacarpal. Do not use soft tissue of the hypothenar eminence for reference.
- Normal ROM: 60-80 degrees.
- Normal end feel: Firm
- 8. Radial Deviation:
- Center the fulcrum on the dorsal aspect of the wrist over the capitate.
- Align proximal arm with the dorsal mid-line of the the forearm. If the shoulder is in 90 degrees of abduction and the elbow is in 90 degrees of flexion, the lateral epicondyle of the humerus can be used for reference.
- Align distal arm with the dorsal mid-line of the third metacarpal. Do not use the third phalanx for reference.
- Normal ROM: 20-25 degrees
- Normal end feel: Hard
- 9. Elbow Flexion
- Center fulcrum over the lateral epicondyle of the humerus.
- Align proximal arm with the lateral mid-line of the humerus, using the center of the arcomion process for reference.
- Align the distal arm with the lateral mid-line of the radius, using the radial styliod process for reference.
- Normal ROM: 140-150 degrees
- Normal end feel: Soft
- 10. Pronation
- Center fulcrum laterally and proximally to the ulnar styloid process.
- Align proximal arm parallel to the anterior mid-line of the humerus.
- Place distal arm across the dorsal aspect of the forearm.
- Normal ROM: 76-84 degrees
- Normal end feel: Hard
- 11. What are some ways patients can cheat?
- Leaning and using other muscles
- Changing positions
- 12. How can cheating affect the outcome of the test?
- You can get a false positive
- You can get a false negative
- 13. What is the importance of proper hand placement?
- The importance of proper hand placement is to assure you are testing the muscle in which you wish to test.
- 14. What is a dance to help you remember the myotomes of the upper body?
- This is a little hard to write out so here are the motions: neck flexion (first 2), lateral neck flexion, shoulder elevation, shoulder abduction, elbow flexion and wrist extension, elbow extension and wrist flexion, thumb abduction and ulnar deviation, and abduction of all the fingers
- 15. Tap/Percussion
- Test Positioning: The athlete may sit or stand with the affected finger extended. The examiner stands in front of the subject.
- Action: The examiner applies a firm tap to the end of the finger being tested. As an alternative method to taping, the examiner may use a percussion hammer.
- Positive Finding: Pain at the site of injury indicates a fracture. The vibration of tapping along the long axis of the bone will exaggerate pain at the fracture site.
- Finkelstein Test
- Test Positioning: The athlete sits or stands and forms a fist around the thumb. The examiner stands with the proximal hand grasping the athlete's forearm and the distal hand grasping the athlete's fist.
- Action: While stabilizing the athlete's forearm with the proximal hand, ulnarly deviate the athlete's wrist with the distal hand.
- Positive Finding: Pain over the abductor pollicis longus and extensor pollicis brevis tendons distally is indicative of tenosynovitis or de Quervain's disease.
- Valgus Stress Test
- Test Positioning: The examiner maintains stabilization of the proximal bone between the thumb and forefinger, and grasps the distal bone.
- Action: The examiner provides a valgus force to the joint, creating a fulcrum while attempting to "grasp the joint".
- Positive Finding: Any excessive gapping that is noted when compared to the uninvolved side may indicate a collateral ligament tear.
- Test Positioning: The examiner maintains stabilization of the proximal bone between the thumb and forefinger, and grasps the distal bone.
- Action: The examiner provides a varus force to the joint, creating a fulcrum while attempting to "gap the joint".
- Positive Finding: Any excessive gapping that is noted when compared to the uninvolved side may indicate a collateral ligament tear.
- 16. Resistive Tennis Elbow Test
- Test positioning: The athlete is in the seated position. The examiner stabilizes the elbow while palpating the lateral epicondyle.
- Action: With a closed fist, the subject pronates and radially deviates the forearm and extends the wrist against the examiner's resistance
- Positive finding: Pain along the lateral epicondyle of the humerus or objective muscle weakness as a result of complaints of discomfort may indicate epicondylitis.
- Passive Tennis Elbow Test
- Test positioning: The athlete sits with the elbow in full extension
- Action: The examiner passively pronates the forearm and flexes the subject's wrist
- Positive Finding: Reports pain along the lateral epicondyle of the humerus may indicate lateral epicondylitis
- Golfer's Elbow Test
- Test Positioning: The athlete sits or stands and makes a fist on the effected side. The examiner faces the subject and palpates along the medial epicondyle. The examiner's other hand grasps the athlete's wrist.
- Action: The examiner passively supinates the forearm and extends the elbow and wrist
- Positive Finding: Complaints of discomfort along the medial aspect of the elbow and wrist
- Test Positioning: The athlete may sit or stand. The examiner stands next to the subject.
- Action: The athlete is instructed to maximally flex the elbow and hold this position for 3-5 minutes.
- Positive Finding: Radiating pain into the median nerve distribution in the subject's arm/hand is a positive finding. A positive test is indicative of cubital fossa syndrome.
- 17. With the athlete that suffered the elbow injury, which injuries do you think could have occurred?
- Dilocation, fracture, bursitis, ect.