Evidence-Based Examination of the Elbow, Wrist, and Hand

Transcription

1 Evidence-Based Examination of the Elbow, Wrist, and Hand Presented by Chad Cook, PT, PhD, MBA, FAAOMPT Practice Sessions/Skill Check-offs Chapter Five: Movement Examination of the Elbow, Wrist, and Hand (45 minutes CEU Time) Skilled Process Flexion Review in Chapter Slide 5 4:51 Photo Description Check Off maximally flex their elbows and their wrist. The Extension Slide 5 4:51 maximally extend their elbows and their wrist. The Supination Slide 6 5:05 maximally supinate their elbows and their wrist. The 1

2 Pronation Slide 6 5:05 maximally pronate their elbows and their wrist. The Wrist Ulnar and Radial Deviation Slide 7 5:30 maximally ulnar and radially deviate their wrist. The Coupled Movements Elbow Flexion Slide 9 7:13 Slide 12 10:03 Active physiological coupled movements include the dart throwing movements of combined wrist extension and radial deviation and wrist flexion and ulnar deviation The test is performed in supine and the elbow is taken to full flexion with a combined varus and valgus force. Stabilize the humerus with the stabilizing hand (right hand in photo) 2

3 Elbow Extension Slide 12 10:03 The test is performed in supine and the elbow is taken to full extension with a combined varus and valgus force. Supination Pronation Slide 13 11:12 Slide 13 11:12 is taken into end range supination. The force is applied near the distal aspect of the wrist for concentration on the full forearm. is taken into end range pronation. The force is applied near the distal aspect of the wrist for concentration on the full forearm. Wrist Flexion and Extension Slide 14 11:45 is taken into end range flexion and extension. The forearm is stabilized to focus the movement through the wrist. 3

4 Wrist Ulnar and Radial Deviation Slide 15 12:38 is taken into end range ulnar and radial deviation. The forearm is stabilized to focus the movement through the wrist. Posterior Anterior of Humeral Ulnar Joint The patient is in prone. The elbow is pulled into extension at the same time the posterior to anterior mobilization is provided with a contact point to the posterior aspect of the ulna. Posterior Anterior of the Humeral Radial Joint n Anterior Posterior of the Humeral Ulnar Joint Anterior Posterior of the Humeral Radial Joint Slide 19 16:29 The patient is in prone. The elbow is pulled into extension at the same time the posterior to anterior mobilization is provided with a contact point to the posterior aspect of the radial head. The patient is in supine. The contact points are placed at the anterior aspect of the ulna. A downward (traction) movement is provided and the elbow is pre-positioned to the limitation. The contact points are placed at the anterior aspect of the radial head. A downward (traction) movement is provided and the elbow is pre-positioned to the limitation. 4

5 Lateral to Medial Glide to Improve Supination Slide 20 18:20 The patient is in sitting and the elbow is pre-positioned in supination. The clinician provides a lateral to medial glide while the patient pushes their own wrist into further supination. Medial to Lateral Glide to Improve Pronation Slide 20 18:20 The patient is in sitting and the elbow is pre-positioned in pronation. The clinician provides a medial to lateral glide while the patient pushes their own wrist into further pronation. n Anterior to Posterior movement of the wrist The wrist is placed palm up and an anterior to posterior glide is performed with an emphasis in making sure the movement is a shear force. Posterior to Anterior movement of the wrist The wrist is placed palm down and a posterior to anterior glide is performed with an emphasis in making sure the movement is a shear force. 5

6 Perform Radial and Ulnar Glides to the wrist Perform Thumb and Finger movements Notes: The wrist is placed thumb down. An ulnar to radial glide is performed. The wrist is placed thumb up. A radial to ulnar glide is performed. Various shear and rotational movements are performed at the PIP, MCP, and DIP of each of the joints. Photos derived from Cook C. Orthopedic Manual Therapy: An Evidence Based Approach. 2 nd edition. Upper Saddle River NJ. Prentice Hall;