Physical Examination of the Hand
J. Terrence Jose Jerome in Clinical Examination of the Hand, 2022
Thumb carpometacarpal (CMC) or scaphotrapezial-trapezoid joints (or both): Patients with CMC arthritis present with varied complaints of localized pain, or vague complaints such as throbbing or burning in the radial aspect of the hand. Advanced osteoarthritis often has adduction contracture thumb and a compensatory MCP joint hyperextension. These patients may show laxity of the joint in hyperextension. A grinding test and joint subluxation test evaluate thumb carpometacarpal joint arthritis. Grinding test: The examiner faces the patient and rests his/her hand on the examination table. Once the wrist is stabilized with the other hand, an axial load is applied to the thumb axis to elicit pain as well as crepitus seen in degenerative arthritis (Video 3.4).CMC subluxation test: The test is similar to the grinding test where the examiner gently forces the CMC joint to subluxate and note the pain and crepitus.
Cervical spine trauma
Sebastian Dawson-Bowling, Pramod Achan, Timothy Briggs, Manoj Ramachandran, Stephen Key, Daud Chou in Orthopaedic Trauma, 2014
A history of severe hyperflexion or hyperextension injury is often reported. Symptoms may be mild leading to missed diagnosis. Classification is according to Anderson and D’Alonzo: Type 1 (5 per cent) – oblique avulsion fracture of tip of dens from alar ligament traction. Uncommon and usually stable with good union rates.Type 2 (60 per cent) – most common fracture occurring at the base of the dens that may cause neurological injury. Unstable with 20–36 per cent risk of non-union.Type 3 (30 per cent) – stable fracture extending into the body; 87–91 per cent rate of union following immobilization.
Management of residual physical deficits
Mark J. Ashley, David A. Hovda in Traumatic Brain Injury, 2017
Muscle endurance of the trunk and lower extremities is assessed by the PT. Trunk endurance (Figure 29.6) testing documents the maximum number of sit-ups performed in 1 minute and the maximum number of push-ups the individual is able to produce. Bridging and hyperextension are each sustained as long as possible (Figure 29.6). Acceptable performance is considered to be 1 minute for bridging and 30 seconds for hyperextension. Cardiovascular endurance can be tested with a standard or modified Bruce™ test43 (Figures 29.7 and 29.8) based on the individual’s level of conditioning. It is very important to monitor heart rate and blood pressure during this exercise. Document the patient’s current medications, which may affect vital signs at rest and during exercise. Advanced endurance testing, such as a physical capacity evaluation, may be performed to address back-to-work potential.
Functional passive range of motion of individuals with chronic cervical spinal cord injury
Published in The Journal of Spinal Cord Medicine, 2020
Sara Kate Frye, Paula Richley Geigle, Henry S. York, W. Mark Sweatman
ROM analysis: Absolute ROM assessment revealed notable differences between individuals with cervical SCI and the general population normative data (Tables 1 and 2). Upper Limb: Shoulder extension was greater in this study population than the general able-bodied population. Elbow extension limitations were prevalent, but of those who could achieve full extension, hyperextension was observed in 10 participants. Wrist extension was greater in the sample population than the general population. Lower Limb: Straight leg raise (SLR) hip flexion, abduction, and internal rotation fell short of the documented ranges for the able-bodied population. Ankle plantarflexion contractures were ubiquitous with the mean being over 10 degrees less than neutral and 23 participants unable to achieve a neutral position in one or both ankles.
Physical functioning and activities of daily living in adults with amyoplasia, the most common form of arthrogryposis. A cross-sectional study
Published in Disability and Rehabilitation, 2018
Unni Steen, Lena Lande Wekre, Nina Køpke Vøllestad
Examination of the hand function showed that 16 participants (73%) had camptodactyly. Nine (41%) had contractures in both the proximal interphalangeal joints and the distal interphalangeal joints of all the fingers, except the thumbs. The metacarpophalangeal joints had limited movements, which affected opening and closing of the power grip. Eight persons (36%) had cupped hands and minimally active movements in the finger joints. Half of those with cupped hands had hypermobile finger joints. All participants had a kind of adducted thumb-in-palm, and all of them had contracted carpometacarpal joints in an adducted position. Only three participants had complete thumb-in-palm contractions as shown in Figure 2. Eleven (50%) of the participants had adduction in the carpometacarpal joint in the thumb together with hyperextension in the metacarpophalangeal joint and/or interphalangeal joint, as shown in Figure 3. No functional problems or pain was described as a consequence of hyperextension.
Surfer’s myelopathy: A review of etiology, pathogenesis, evaluation, and management
Published in The Journal of Spinal Cord Medicine, 2021
Jason Gandhi, Min Yea Lee, Gunjan Joshi, Sardar Ali Khan
SM is hypothesized to be caused by hyperextension of the spine thus leading to vascular damage and ischemia to the distal spinal cord segment.1 As novice surfers generate excessive force by maneuvering the surf boards and surrounding waves, tension on both the spinal cord and its vasculature increases. While most studies suggest this acute hyperextension is a predictor of SM, a study by Freedman et al. has posited alternative etiologies.7 The authors proposed that inferior vena cava compression or embolization within the spinal arteries, both secondary to prolonged hyperextension, are the root causes. This may explain why the lower spinal cord and conus medullaris may be vulnerable to arterial insufficiency.6 An alternative explanation is that affected patients have a thin body habitus concomitant with weak musculature, dehydration, and long distance travel.1
Related Knowledge Centers
- Anatomy
- Standard Anatomical Position
- Carpal Bones
- Joint
- Intervertebral Disc
- Shoulder
- Limb
- Anatomical Plane
- Wrist
- Metacarpal Bones