Part 4 chiropractic NBCE- orthopedics
Terms in this set (21)
wrists are bent down with backs of each hand touching / carpal tunnel sufferers feel tingling or pain within 60 seconds
Patient hand supinated and supported in one hand. Tap the palmar surface of the wrist
+ tingling in the hand in distribution of the medial nerve: Carpal Tunnel Syndrome
Used to determine the patency of the ulnar and radial artery. While compressing one of either artery, the patient makes a tight fist pumping, Doc close off the superficial arteries. When the patient opens their hand, lift off one artery, normal color should return. Repeat on other artery.
Muscle test for C6-C7
with hand supine, flex wrist, abduction Flexor carpi radialis Median nerve C6, C7
Active range of motion of the wrist
Do good wrist first. Normal is flexion 80 degrees, extension 70 degrees. Ulnar deviation 30 degrees, radial deviation 20 degrees.
AKA Nercrosis of Lunate
Increased Lunate density
Previous trauma; dominant hand use
Localized and radiating wrist pain; swelling and disability
Ulnar nerve palsy
damage to the ulnar nerve running through the groove of the elbow. Caused by excessive leaning on the elbow,often seen in alcoholics or by abnormal bone growth in children. Causes sensory deficits in 5th and medial half of 4th finger. Can lead to claw hand deformity
a harmless fluid-filled swelling that occurs most commonly on the outer surface of the wrist
Carpal tunnel syndrome
Painful, inflammatory, carpal or wrist portion of the median nerve. caused by repetitive actions- typing, screwdriver. AKA median nerve intrapment, pronator teres syndrome. Middle, index & thumb, thenar atrophy. Fallon and reverse Fallen tests, and Tenel's test.
C7 nerve root involvement
A disc at C7-T1 produces a C8 nerve root impingement. Finger flexors . Test with supine flexion of wrist.
Median nerve entrapment
median nerve may be entrapped at the humeral and ulnar heads of pronator teres
supracondylar process create foramen for median nerve to pass. Can cause Carpal tunnel syndrome.
inflammation of the synovial sheaths on the back of the wrist, producing pain in the wrist
Instruct patient to actively flex head and neck to chest. Positive test is sharp electric shocks down spine and into upper or lower limbs. Demyelination of cord, can idicate Multiple sclerosis.
Patient seated, actively places palm of effected extremity on top of head, raising elbow to level of head. Pain decreases or disappears indicates nerve root / cervical foraminal compression.
Shoulder depression test
patient seated, doc depresses shoulder on affected side and laterally flexes c -spine away from that shoulder in scissor like move. Positive is radicular pain or aggravated indicates adhesions in dural sleeves, spinal nerve roots or shoulder joint capsule.
patient supine, doc places hand on sternum and passively flexes head to chest. If female use her hand. pain= posterior ligament problem or sprain , or anterior compression fracture.
patient seated. active ROM of c -spine with resistance, and then passive ROM. Pain during active resisted = muscle strain. Pain in passive = ligament sprain.
Ask patient to take deep breath, hold and bear down. Increased pain indicates increased intrathecal pressure, space occupying lesion, herniated disc, tumor or osteophtes.
Maximum cervical compression test
Patient seated. Actively rotates head and hyperextends neck toward side of complaint. Test bilaterally. If no pain, may look down, if pain NO. Suggests muscular strain, or foraminal encroachment.
palpate radial pulse while drawing patient's shoulder down and into extension. Patient flexes c-spine to chest. Confirms costoclaviculr syndrome.
Wright's test. AKA Hyperabduction maneuver
Patient seated while examiner palpates radial pulse. Both arms abducted to 180 degrees. Note angle of abduction when pulse diminishes or stops on affected side. Hyerabduction or pectoralis minor syndrome.
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