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Cards In This Set
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Tennis Elbow or Lateral Humeral Epicondylitis
* In this area tissues are easily damaged and have the lowest blood circulation *The areas of the worst circulatory and metabolic supply are located at the place of attachment of the flexor and extensor muscles to the periosteum of the humerus. *This condition occurs on the lateral epicondyle fue to the minute ruptures or inflammation usually at the origin of the extensor carpi radialis brevis but can involve the entire extensor compartment Causes: Chronic physical overlead of the forearm extensors causing a button hole tear. Signs and symptoms of Injury -Flexing the wrist while extending the elbow -Trying to straighten the wrist against resistance while extending the elbow -Trying to extend the wrist against resistance while extending the elbow -Trying to extend the fingers against resistance. Main complaint: -Pin point burning pain located in the area of the lateral epicondyle of the humerus -Pain initially appears when the clients contracts the extensor muscles. -An increase in local temperature, oedema, as well as hyperaemia can be found |
Tennis elbow test:
-Therapist palpate the lateral condyle of the humerus with their thumb while placing contact over the dorsum of the client's hand. -client make a fist and attempts to extend their wrist as the therapist applies an over pressure into the motion of flexion -A positive test = pain at the lateral condyle of the humerus Treatment: * Take them back to acute condition and control the healing. 1-Reduce or stop the activity that caused the condition 2-Assess and treat any pre-existing conditions in the arm and/or forearm. 3-LCF With a finger on the site of inflammation, extend the elbow and flex the wrist at the same time and vice versa. 4- move 1 inche off the condyle and change attachement site. 5-Deep ice friction to the area with a mild stretch on the tendon. 6-Stretching techniques of the extensor compartment are also an important component in the treatment of this condition. 7-cortizone and ultrasound can also be very beneficial. 8-Brace over extensor tendon |
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Golfer Elbow or Medial Humeral Epicondylitis
* In this area tissues are easily damaged and have the lowest blood circulation *The areas of the worst circulatory and metabolic supply are located at the place of attachment of the flexors muscles to the periosteum of the humerus. *This condition occurs on the medial epicondyle due to the minute ruptures or inflammation usually at the origin of the entire flexor compartment Causes: Chronic physical overlead of the forearm flexors causing a button hole tear. Main complaint: -Pin point burning pain located in the area of the medial epicondyle of the humerus -Pain initially appears when the clients contracts the flexors muscles. -An increase in local temperature, oedema, as well as hyperaemia can be found |
Golfer elbow test:
-Therapist palpate the medial condyle of the humerus with their thumb while placing contact over the anterior aspect of the client's hand. -client make a fist and attempts to flex their wrist as the therapist applies an over pressure into the motion of extension -A positive test = pain at the medial condyle of the humerus Treatment: * Take them back to acute condition and control the healing. 1-Reduce or stop the activity that caused the condition 2-Assess and treat any pre-existing conditions in the arm and/or forearm. 3-LCF With a finger on the site of inflammation, flex the elbow and extend the wrist at the same time and vice versa. 4- move 1 inche off the condyle and change attachement site. 5-Deep ice friction to the area with a mild stretch on the tendon. 6-Stretching techniques of the extensor compartment are also an important component in the treatment of this condition. 7-cortizone and ultrasound can also be very beneficial. 8-Brace over flexor tendon |
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Carpal tunnel syndrome
* True carpal tunnel syndrome results from constriction of the median nerve as it passes through the carpal tunnel fo the wrist Causes: *inflammation of the tendons of flexors digitorum superficialis and flexor digitorum profundus and flexor pollicus longus * subscapularis can refer pain exactly like carpal tunnel Sings and symptoms of injury -Pain , tingling and sensation alteration along the thenar eminence and radial side of the hand, including the thumb,index, middle or ring fingers but not your little fingers -sensation occurs while driving a vehicle of holding a phone or a newspaper or upon awakening -Pain radiating or extending from your wrist up your arm to your shoulder or down into your palm or fingers, expecially after forcefull or repetitive use. This usually occurs on palm side of your forearm. -Shake their hand to releive symptoms. -Paraesthesia at night that wakes them up. -burning sensatino down their arm and into the hand -Atrophy of the thenar muscles in the hand may also be seen. -feeling of weakness in your hand and a tendency to drop object. -A constant loss of feeling in some fingers if the condtion is advance. |
Tinnel's sign
1-Therapist tap over the volar ( anterior surface) carpal ligamentat the client's wrist. Positive=tingling into the thumb, index and middle finger Phalens Test * pronator teres problem ( nerve pass through) A-client forearms are supinated and elbows flexed. -client places the sorsum of thier hands together and extends their elbows to induce wrist flexion. ( facing up ) -Hold for 30-45 seconds Positive= reproduction of the client's symptoms B-do the same thing but client's forearm are pronated instead of supinated ( facing down) Positive=symptoms disappear ( thighness of pronator teres) Treatment: *Having a brace over the wrist will aggravate the symptoms if the fingers are working all the times *Rule out and treat any primary dysfunctions that may be mimicking CTS symptoms ( Shoulder/neck) -Adson test (scalene) or Wrights test ( pec minor) can be used to rule out thoracic outlet syndrome as a cause of the hand symptoms -Commeon for ischemic point to occur in the subscapularis and/or palmaris longus muscles that refer similar symptoms to CTS. 1-Massage to warm the area and then deep ice friction the area of the carpal tunnel to reduce any fibrotic tissue, breakdown adhesion to scar tissue that may be present. 2-Petrissage mouvements may help drain the area 3-Deep moist heat/wax bath to affect the fascia and deep restrictions is very beneficial if no swelling is present 4-Repulsive hot/cold bath is also indicated for treatment in this condition. 5-Rest from the causative factor allows the swollen and inflamed synovial memebranes to shrink, this relieves the pressure on the nerve. 6-Pain free passive stretches of the wrist flexors and extensors along with squeezing and gripping exercises can be very helpful. 7-Mild cases may be treated by applying a brace or splint which is usually worn at night an keeps your wrist from bending 8-Non-steroidal anti-inflammatories taken by mouth may also help with inflamed membranes. 9-Surgically, carpal tunnel may be relieved by cutting the transverse carpal ligament or scrape the bones to make more space 10-6 weeks after the surgery, start friction and break scar tissue as often as they can think about to help reduce scar tissue adhesions. |
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De Quervain's Disease
Stenosing Tenovaginitis, Snapping thumb syndrome, Radial tenosynovitis Thickening of the tendon sheath of the abductor pollicus longus and the extensor pollicus brevis Causes: -acute trauma or repetitive wringing type motions of the wrist. -Synovial lining of the tendon sheaths become inflamed which may cause narrowing of the tunnel oppening at the distal aspect of the radius. -Calcareous deposit in the sheat Signs and symptoms -Pain and swelling near the base of your thumb -pain may appear suddenly or may increase over time. -Without treatment, the pain may sperad farther into your thumb, back into your forearm or both -Pinching, grasping and other movement of the thumb and wrist aggravate the pain -Numbness in the back of your thumb and index finger, caused by the swollen tendon rubbing on a nerve. -A fluid-filled cyst in the same region as the swelling and pain -Difficulty moving the thumb/wrist when doing activities that involve grasping or pinching -A Sticking or stop-and-go sensation in your thumb when trying to move it. -A squeakin sound as the tendons try to move back and forth through the inflamed sheats. |
Finkelsteins Test ( Harry Finkelsteins 1930)
-client forearm in a neutral position -Therapist holding the thumb in a neutral position -Therapist passively applies a Sharp ulnar deviation motion Positive=reproduction of client's symptoms treatment *Disease is progressive, not amenable except in rare instances, to conservative treatment after four weeks duration but responds readily to operative intervention. ( splitting the stenosed tendon sheat or in severe cases, the entire removal of the tendon sheath.) -Assess and treat any pre-existing conditions in the hand and/or forearm. -Rest from the causative factors for apporoximately 10 days is very benevicial as are anti-inflammatories. -Application of moist heat, paraffin wax bath are also beneficial in helping reduce inflammation. -Deep ice friction as heavily as the client can tolerate for 10 minutes at each session to help dissipate any nodule formations which may be present. |
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Dupuytrens Contracture
Thickening of the palmar aponeurosis with progressive developement of flexion contractures in the metacarpophalangeal and proximal interphalangeal joints causing contraction of the extensors tendon of the ring and pinky finger. Signs and symptoms early stage local tickening and one or more painless fibrotic nodules usually over the pretendinous fourth digit. Advance stage -palmar aponeurosis turns into cord like longitudinal bands as well as at the same time, flexion contractures in the metacarpophalangeal and proximal interphalangeal joints of the fouth and fifth digit occur. -The skin becomes adherent to the changed palmar aponeurosis and the pretendinous bands. -Loss of full ROM of the fouth and fifth digit in extension Prevention *All of the following are controversial -Citrus fruit, unsaturated fatty acids of native olive oil, soybeans are all said to contain specific scavengers , which may give explanation to the lack in prevalence of Dupuytren's in the Mediterranean and Asian population. -Vitamins ACDE and selenium may slow the fibro-proliferation of the disease. -Interferon, Difedipine and Verapmil are other drugs that were tried with limited success -Collagenase: This enzyme is injected into diseaded fascia cuasing it more or less to dissolve. Still in clinical trials but shows great promise. |
Treatment
*There is no cure for this disease. With surgery there is a rate of recurrence, about 50% of patients experience recurrence of the conditions within 2 or 3 years. -Treatment involves assessing and treating any pre-existing contidions in the arm and forearm -Thorough preparatory massage to the volar and dorsal aspect of the forearm/wrist and hand -Small, deep frictional strokes in the area of the fibrotic nodule if present, follewed by deep stripping strokes along the pretendonous bands of the second to fifth digits. -Stretching of the palmar aponeurosis by overextendign each digit as well as palmar rolling . -Isometrics may be beneficial -May require surgery in the advance stage. Surgical procedures: -Regional FAsciectomy: complete excision of the deseased fascia of the palm and digits. Long rehab and wound care are needed. -Needle Aponovrotomy: A small hypodermic needle through a skin prick is used to divide and release the contracting bands. -Fasciotomy: Hand incision or multiple incisionas are made above the hardened Dupuytren's cord and sharp dissection is performed to facilitate release. Diseased tissue is not removed. -Dermofasciectomy: Removal of diseased fascia as well as diseased skin overlying diseased fascia. The diseased skin is replaced by a skin graft taken from patient's arm. Long rehab and wound care is needed, less recurrence. Non-Invasive Pneumatic balloon extension procedure: A metal plate fitted to the palm. this plate secures a balloon and pneumatic assemblage where the patient can slowly increase the pressure to facilitate extension/traction. this device is primarily used to straighten severely contracted digits so that then will be more amenable to a surgical methods as described above. |
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Trigger Finger
-Type of tendonitis that occurs when the tendon sheath becomes swollen or thickened within the flexor tendon pulley system preventing the tendon from sliding freely. -The constant irritation frome the tendon repeatedly sliding through the pulley causes the tendon to swell in this area and create the nodule. -Infection or damage to the synovium causes a rounded swelling ( the nodule) to form in the tendon which can cause the tendon to catch and then releases crating a snappoing or popping. causes: -overuse -Rheumatoid arthritis -partial tendon lacerations -Repeated trauma from pistol-gripped power tools -long hours grasping a steering wheel -Client with diabete or gout can have several finger involve. signs and symptoms -Start without injury -Stiffness and catching tend to be worse after inactivity, such as when you wake in the morning, finger will loosen up with activity. -Pain when the finger or thumb is flexed and staightened. -Tenderness usually occurs over the area of the nodule which is at the bottom of the finger or thumb. -A clicking sensation occurs when the nodule moves through the tunnel formed by the pulley ligaments. With the finger straight, the nodule is at the far edge of the surronding ligament. When the finger is flexed the nodule passes under the ligament and cuases the clicking sensation. -If the nodule becomes too large it may pass under the ligament but becomes stuck at the near edge. The nodule cannot move back through the tunnel and the finger is locked in the flexed trigger position. -Sometimes, one or moere fingers are being involve. |
Treatment
-Assessing and treat any pre-existing conditions in the arms and or forearm. -Massage of the volar and dorsal aspects of the forearm, wrist and hand with small deep fricitional strokes in the area of the fibrous nodule is beneficial. when symptoms become less acute, increase the lenght and depth of the treatment. -Anti-inflammatories and rest for approximately two-four weeks -Moist heat application -Rest: 2-4 weeks, change or curtail work or personal activities that require repeated gripping actions. -Splinting: Wearing a splint to keep the affected finger in an extended position for up to 6 weeks. Help from curling your finger into a fist while sleeping. Avoiding repetitive gripping, grasping or the prolonged use of vibrating machinery.: 3-4 weeks -Soaking in warm water: in the morning this may reduce the severity of the catching sensation during the day. Repeat soaking during the day. |
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Raynauds Vascular Disorder
A condition where vasospasm ( constriction of small arteries) of the hands and/or feet occurs. Without any know causes: Raynaud's disease or primary Raynaud's Along with a cause: Raynaud's phenomenon or secondray Raynaud's Signs and symptoms: -digital blanching, cyanosis, a feeling of numbness or dulled sensory response and rubor after cold exposure and rewarming. -Can be induced by anxiety/fear or stress. -Can also affect area like nose, cheeks, ears, nipples and even the tongue -client complains of a numb, tingly or stinging pain in the area upon warming or relief of the stressful or fearful situation. -First attack: skin usually turn white. Then, the areas turn blue and feel cold and numb and your sensory perception is dull. The affected skin may look slightly swollen. -As circulation improves, the affected areas may turn red, throb tingle or swell. -Not everyone experience the three color. -Most commonly affects the middle 3 fingers and rarely affects the thumb. |
Treatment
-Massage of the hands and feet to affect the circulation as well as repulsive baths ( on a daily basis and start and stop with hot water) -Vitamin E is also of great benefit in its effect tot he circulatory system -client should avoid unnecessary cold exposure and wear warm clothing. In addition to the hands and feet, the trunk and head shlud be kept warm to avoid reflex vasoconstriction. -Stop smoking because nicotine is a vasoconstrictor -Relaxation technique like biofeedback may reduce vasospastic episode. -Revolutionary surgical technique that is minimally invasive called ETS ( endoscopic thoracic sympathectomy) through a single 1/12 inch axiallary incision. Upon completion of bilateral micro ETS of T2 and T3 clients have noted warm/dry fingers and hands. |
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Ganglions/Bible cysts
-Tumor or swelling on top of a joint or the covering of a tendon. -It looks like a sac of liquid ( cyst). Inside the cyst is a thick , sticky, clear, colorless, jelly like material. -Depending on the size, cysts may feel firm or spongy. -3X more common in woman and 70% occur in people between the ages of 20-60. -commonly occur on the back of the hand 60-70% at the wrist joint and can also develop on the volar aspect of the wrist. -The scapho-lunate joint accounts for 80% of all ganglion cyst. -A volar wrist ganglion typically appears on the wrist crase just below the thumb. This is the second common type of wrist ganglion Signs and symptoms: -Smaller ganglions that remain hidden under the skin ( occult ganglions) may be quite painful. -The ganglions may also interfere with activities. -A volar wrist ganglion may compress the median or ulnar nerve, causing trouble sith sensation and movement. -Typically the symptoms from a ganglion are not harmful and do not grow worse. -These cysts will not turn into cancer. Causes: -idiopathic -May occur over time if previous infection in area, due to connective tissue degeneration. -Previous injury to wrist -Repetitive injury: tennis, golf, gymnastic -May be form when connective tissue degenerate or damaged by wear and tear. The damage tissue forms a weakened spot in the joint capsule. The joint fluid seems to move out of the wrist joint into the ganglion but not the other way. Over time the cyst grow larger -In the end, a clear sticky fluik fills the cyst. ( a mix of chemicals normally found in the joint.) |
Treatment:
* initial treatment is not surgical 1-Observation: Make sure not unusual changes occur. 2-Immobilization: Activity often causes the ganglion to increase in size and increase presure on nerves, causing pain. -A wrist brace or splint may relieve symptoms, letting the ganglion decrease in size. -As pain decrease, exercises to strenghten the wrist and improve range of motion are beneficial. 3-Aspiration: If there is too much pain or limitation of normal activities, the fluid may be drained frome it. -The cyst can grow again -Surgery may also include removing part of the involved joint capsule or tendon sheath. Normal activities may be resumed 2-6 weeks after surgery. |
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Elbow flexion restriction
Agonists: bicep brachii brachialis brachioradialis Antagonists: Triceps brachii Anconeus |
1-General assessment:
A-Upper extremity test * Monitor the position of elbow flexion and wrist pronation/supination B-Active Range of motion -client is seated or standing -Keep elbows close to side -Client flexed supinated foream through full ROM started at the fully extended position -Monitor for quality and quantity of mouvment -Compare both sides Positive=Assymetry 2-Specific assessment A-Passive Range of Motion -client is seated or standing -Therapist stabilize elbow with one hand and grasps client's wrist with the other -Therapist flexed client elbow to the end range -Monitor for quality and quantiyty of movement. -Compare both sides Positive=asymmetry on one side (hypertonicity or contracture in triceps, anconeus) B-Resisted test for elbow flexors -client is seated or standing with elbows at their side and flexed to 90* -Therapist grasps the distal anterior aspect of radius and ulna -Apply a non-yielding resistance for 6 seconds as the client attempts to flex their elbow. -Compare both side * watch for client using their errectors spinae instead of their elbow flexors. -Positive=uneven strenght ( nerve impingement or weakeness in biceps, brachialis and brachioradialis) C-Palpation Treatment: A-Extrinsic application B-Isometrics for thightness of elbows extensors -Client is seated or standing -Therapist stabilizes client's elbow at their side -Therapist contracts the distal posterior aspect of the client's radius and ulna -Passively flex client's elbow the the first barrier -Provide a non-yielding resistance as the client attempts to extend their elbow for 7-10 seconds. -Take up any elongation and repeat this protocol 3-5 X C-Isotonic for weakeness of the elbow flexors -Client is seated or standing -Therapist stabilize client's elbow at their side -Therapist contact the distal ventral aspect of the client's radius and ulna -Passively extend client's elbow to the end rage of motion -Provide a yielding resistance as the client attempts to flex their elbow through the full ROM -Repeat 3-5X D-Exercises rehabilitation to be continued at home E-Watch for any of these associated conditions -G.H. Flexion restriction -G.H. Horizontal adduction restriction -G.H. Abduction restriction. -Supination restriction of the elbow ( weakness) |
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Elbow extension restriction
Agonists: Triceps brachii Anconeus Antagonists: bicep brachii brachialis brachioradialis |
1-General assessment:
A-Upper extremity test * Monitor the position of elbow flexion and wrist pronation/supination B-Active Range of motion -client is seated or standing -Keep elbows close to side -Client extends supinated arms through full ROM at the fully flexed position -Monitor for quality and quantity of mouvment -Compare both sides Positive=Assymetry 2-Specific assessment A-Passive Range of Motion -client is seated or standing -Therapist stabilize elbow with one hand and grasps client's wrist with the other -Therapist extend client elbow to the end range -Monitor for quality and quantiyty of movement. -Compare both sides Positive=asymmetry on one side (hypertonicity or contracture in biceps, brachialis or brachioradioalis) B-Resisted test for elbow extensors -client is seated or standing with elbows at their side and flexed to 90* -Therapist grasps the distal posterior aspect of radius and ulna -Apply a non-yielding resistance for 6 seconds as the client attempts to extend their elbow. -Compare both side * watch for client using their abdominal muscles, hip flexors instead of their elbow extensors. -Positive=uneven strenght ( nerve impingement or weakeness in triceps or anconeus) C-Palpation Treatment: A-Extrinsic application B-Isometrics for thightness of elbows flexors -Client is seated or standing -Therapist stabilizes client's elbow at their side -Therapist contracts the distal anterior aspect of the client's radius and ulna -Passively extend client's elbow the the first barrier -Provide a non-yielding resistance as the client attempts to extend their elbow for 7-10 seconds. -Take up any elongation and repeat this protocol 3-5 X C-Isotonic for weakeness of the elbow extensors -Client is seated or standing -Therapist stabilize client's elbow at their side -Therapist contact the distal posterior aspect of the client's radius and ulna -Passively flex client's elbow to the end rage of motion -Provide a yielding resistance as the client attempts to extend their elbow through the full ROM -Repeat 3-5X D-Exercises rehabilitation to be continued at home E-Watch for any of these associated conditions -G.H. extension restriction -G.H. Horizontal abduction restriction -Pronation restriction of the elbow ( weakness) |
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Elbow supination restriction
Agonists: Supinators Biceps brachii Antagonists: Pronator teres Pronator quadratus |
1-General assessment:
A-Upper extremity test * Monitor the position of wrist pronation/supination B-Active Range of motion -client is seated or standing with forearm flexed at 90* * Have a pen in their hand is easier to see -Keep elbows close to side -Client starts in a neutral position and supinates forearms -Monitor for quality and quantity of mouvment -Compare both sides Positive=Assymetry 2-Specific assessment A-Passive Range of Motion -client is seated or standing with elbow flexed at 90* -Therapist stabilize elbow with one hand and grasps distal forearm with the other. -Therapist induce supination -Monitor for quality and quantity of movement. -Compare both sides Positive=asymmetry on one side (hypertonicity or contracture Pronator teres or pronator quadatus) B-Resisted test for wrist supinators -client is seated or standing with elbows at their side and flexed to 90* -Therapist grasps the distal posterior of the radius and ulna between their clasped hands -Apply a non-yielding resistance for 6 seconds as the client attempts to pronate their elbow. -Compare both side -Positive=uneven strenght ( nerve impingement or weakeness in bicep brachii or supinator) C-Palpation Treatment: A-Extrinsic application B-Isometrics for thightness of pronators -Client is seated or standing -Therapist stabilizes client's elbow at their side -Therapist clasp their fingers together and grasps the distal aspect of the client's radius and ulna between their hands. -Passively supinate client's forearm the the first barrier -Provide a non-yielding resistance as the client attempts to pronate their forearm for 7-10 seconds. -Take up any elongation and repeat this protocol 3-5 X *Do not resist directly over wrist and encure the therapists grasp does not induce and inhibitotry painful reaction. C-Isotonic for weakeness of the forearm supinators -Client is seated or standing -Therapist stabilize client's elbow at their side -Therapist clasps their fingers together and grasps the distal aspect fot he client's radius and ulna between their hands -Passively pronate client's forearm to the end rage of motion -Provide a yielding resistance as the client attempts to supinate their elbow through the full ROM -Repeat 3-5X D-Exercises rehabilitation to be continued at home E-Watch for any of these associated conditions -G.H. flexion restriction -G.H. Horizontal adduction restriction |
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Elbow Pronation restriction
Agonists: Pronator teres Pronator quadratus Antagonists: Supinators Biceps brachii |
1-General assessment:
A-Upper extremity test * Monitor the position of wrist pronation/supination B-Active Range of motion -client is seated or standing with forearm flexed at 90* * Have a pen in their hand is easier to see -Keep elbows close to side -Client starts in a neutral position and pronate forearms -Monitor for quality and quantity of mouvment -Compare both sides Positive=Assymetry 2-Specific assessment A-Passive Range of Motion -client is seated or standing with elbow flexed at 90* -Therapist stabilize elbow with one hand and grasps distal forearm with the other. -Therapist induce pronation -Monitor for quality and quantity of movement. -Compare both sides Positive=asymmetry on one side (hypertonicity or contracture Biceps brachii and/or supinator) B-Resisted test for wrist pronation -client is seated or standing with elbows at their side and flexed to 90* -Therapist grasps the distal posterior of the radius and ulna between their clasped hands -Apply a non-yielding resistance for 6 seconds as the client attempts to supinate their elbow. -Compare both side -Positive=uneven strenght ( nerve impingement or weakeness in pronator teres or pronator quadratus) C-Palpation Treatment: A-Extrinsic application B-Isometrics for thightness of supinators -Client is seated or standing -Therapist stabilizes client's elbow at their side -Therapist clasp their fingers together and grasps the distal aspect of the client's radius and ulna between their hands. -Passively pronate client's forearm the the first barrier -Provide a non-yielding resistance as the client attempts to supinate their forearm for 7-10 seconds. -Take up any elongation and repeat this protocol 3-5 X *Do not resist directly over wrist and encure the therapists grasp does not induce and inhibitotry painful reaction. C-Isotonic for weakeness of the forearm pronators -Client is seated or standing -Therapist stabilize client's elbow at their side -Therapist clasps their fingers together and grasps the distal aspect fot he client's radius and ulna between their hands -Passively supinate client's forearm to the end rage of motion -Provide a yielding resistance as the client attempts to pronate their elbow through the full ROM -Repeat 3-5X D-Exercises rehabilitation to be continued at home E-Watch for any of these associated conditions -G.H. extension restriction -G.H. Horizontal abduction restr |
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Wrist flexion restriction
Agonists: Wrist flexors group Antagonists: wrist extensor group |
1-General assessment:
A-Active Range of motion -client is seated or standing -Keep elbows close to side, forearm supinated, hand in fist -Client flexed supinated wrist through full ROM started at the fully extended position -Monitor for quality and quantity of mouvment -Compare both sides Positive=Assymetry 2-Specific assessment A-Passive Range of Motion -client is seated or standing -Therapist stabilize elbow with one hand and grasps client's wrist with the other -Therapist flexed client wrist to the end range -Monitor for quality and quantity of movement. -Compare both sides Positive=asymmetry on one side (hypertonicity or contracture wrist extensors group) B-Resisted test for wrist flexors -client is seated or standing with elbows at their side and flexed to 90* -Therapist stabilizes client's arm and places hand over the client palm -Apply a non-yielding resistance for 6 seconds as the client attempts to flex their wrist -Compare both side -Positive=uneven strenght ( nerve impingement or weakeness wrist flexors) C-Palpation Treatment: A-Extrinsic application B-Isometrics for thightness of wrist extensors -Client is seated or standing -Therapist stabilizes client's elbow at their side -Therapist contracts the distal anterior aspect of the client's radius and ulna -Passively flex client's wrist the the first barrier -Provide a non-yielding resistance as the client attempts to extend their wrist for 7-10 seconds. -Take up any elongation and repeat this protocol 3-5 X C-Isotonic for weakeness of the wrist flexors -Client is seated or standing -Therapist stabilize clients arm and places hand ovcer the clients palm. -Passively extend client's wrist to the end rage of motion -Provide a yielding resistance as the client attempts to flex their wrist through the full ROM -Repeat 3-5X D-Exercises rehabilitation to be continued at home E-Watch for any of these associated conditions -golfer elbow ( medial epicondylitis) |
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Wrist extension restriction
Agonists: Wrist extensors group Antagonists: wrist flexors group |
1-General assessment:
A-Active Range of motion -client is seated or standing -Keep elbows close to side, forearm pronated, hand in fist -Client extendend pronated wrist through full ROM started at the fully flexed position -Monitor for quality and quantity of mouvment -Compare both sides Positive=Assymetry 2-Specific assessment A-Passive Range of Motion -client is seated or standing -Therapist stabilize elbow with one hand and grasps client's wrist with the other -Therapist extend client wrist to the end range -Monitor for quality and quantity of movement. -Compare both sides Positive=asymmetry on one side (hypertonicity or contracture wrist flexors group) B-Resisted test for wrist extensors -client is seated or standing with elbows at their side and flexed to 90* -Therapist stabilizes client's arm and places hand over the client palm -Apply a non-yielding resistance for 6 seconds as the client attempts to extend their wrist -Compare both side -Positive=uneven strenght ( nerve impingement or weakeness wrist extensors) C-Palpation Treatment: A-Extrinsic application B-Isometrics for thightness of wrist flexors -Client is seated or standing -Therapist stabilizes client's elbow at their side -Therapist contracts the distal posterior aspect of the client's radius and ulna -Passively extend client's wrist the the first barrier -Provide a non-yielding resistance as the client attempts to flex their wrist for 7-10 seconds. -Take up any elongation and repeat this protocol 3-5 X C-Isotonic for weakeness of the wrist extensors -Client is seated or standing -Therapist stabilize clients arm and places hand over the clients palm. -Passively flex client's wrist to the end rage of motion -Provide a yielding resistance as the client attempts to extend their wrist through the full ROM -Repeat 3-5X D-Exercises rehabilitation to be continued at home E-Watch for any of these associated conditions -Tennis elbow ( lateral epicondylitis) |
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Wrist Ulnar deviation/adduction restriction
Agonists: Flexor carpi ulnaris Extensor carpi ulnaris Antagonists: flexors carpi radialis extensor carpi radialis brevis and longus |
1-General assessment:
A-Active Range of motion -client is seated or standing -Keep elbows close to side, forearm supinated, and flex to 90* -Client ulnar deviate their wrist through full ROM -Monitor for quality and quantity of mouvment -Compare both sides Positive=Assymetry 2-Specific assessment A-Passive Range of Motion -client is seated or standing, forearm supinated and flexed to 90* -Therapist stabilize the clients forearm with one hand and grasps the clients hand in a shake hand position -With their opposite hand apply passifve ulnar deiviation of the client's wrist to the end ROM -Monitor for quality and quantity of movement. -Compare both sides Positive=asymmetry on one side (hypertonicity or contracture Flexor carpi radialis and/or extensor carpi radialis brevis, longus) B-Resisted test for wrist ulnar deviators -client is seated or standing with elbows at their side and flexed to 90* -Therapist stabilizes client's forearm with one hand and grasps the clients hand in a shake hand position with their opposite hand. -Apply a non-yielding resistance for 6 seconds as the client attempts to ulnar deviate their wrist -Compare both side -Positive=uneven strenght ( nerve impingement or weakeness of flexor carpi ulnaris and /or extensor carpi ulnaris) C-Palpation Treatment: A-Extrinsic application B-Isometrics for thightness of radial deviator -Client is seated or standing with elbows at their side, forearm supinated and flexed to 90* -Therapist stabilizes client's forearm with one hand and grasps the clients hand in a shake hand position with their opposite hand. -Passively ulnar deviate client's wrist the the first barrier -Provide a non-yielding resistance as the client attempts to radial deviate their wrist for 7-10 seconds. -Take up any elongation and repeat this protocol 3-5 X C-Isotonic for weakeness of the wrist ulnar deviators -Client is seated or standing with elbows at their side, forearms supinated and flexed to 90* -Therapist stabilize clients forearm with one hand and grasps the client's hand in a shake hand position with their opposite hand -Passively radial deviate client's wrist to the end rage of motion -Provide a yielding resistance as the client attempts to ulnar deviate their wrist through the full ROM -Repeat 3-5X D-Exercises rehabilitation to be continued at home |
