CHT Exam - Evaluation Questions And Answers

Components of evaluation process - ANS 1. demographic information 2. History of injury 3. Observations 4. Edema 5. ROM 6. Strength 7. Sensation 8. Coordination 9. Provocative testing Components of clinical observations - ANS 1. inspection 2. wounds/scar 3. trophic changes 4. vasomotor status Aspects of clinical inspection - ANS atrophy, edema, congruency of bony landmarks, nodules/wrinkles/calluses/contractures/deformities, cascade of metacarpals, redness, skin changes Possible observable trophic changes - ANS Nail growth, shape, colour Components of a vasomotor exam - ANS Cap refill and pulses Reasons for poor circulation - ANS smoking, diabetes, autoimmune disorders, cardiac disease, occupational factors Types of edema - ANS -Pitting - acute -Brawny - chronic Ways to measure edema - ANS Volumeter Circumference Figure of 8 Truncated measure AROM - ANS Muscular ability to move a joint Limitation due to edema, contracture, denervation, adhesions, subluxations, fractures PROM - ANS Ability of a joint to move through its normal arc of movement Limitations associated with capsular tightness, contractors, joint incongruity, malunited fractures, and fixed deformities Strength assessment - ANS Most common strength assessment = MMTs Weakness may be associated with peripheral nerve injury, CNS injury, atrophy, or pain Grip strength Grip strength testing - ANS average of three trials on level 2 with dynamometer 5-run grip test Rapid exchange grip test Sensation assessments - ANS 1. Semmes-Weinstein style monofilament 2. two point discrimination 3. vibration 4. O'Riain's wrinkle test 5. Ninhydrin test Semmes Weinstein Monofilament Test - ANS standardized, valid and sensitive Ability to discriminate light touch to deep pressure Tests innervation of median, ulnar, and radial nerves Test is repeated three times for 1.65-4.08 and once for 4.31-6.65 Semmes Weinstein Monofilament Test norms - ANS 1.65-2.83 normal 3.22-3.61 diminished light touch 3.84-4.31 diminished protective sensation 4.56-6.65 loss of protective sensation 6.65 undetectable Two point discrimination - ANS - tests ability to distinguish between 2 stimuli - Testing starts at 5 mm distance between tips and ends at 15mm Vibration testing - ANS - uses tuning fork - subjective and difficult to reproduce O'Riain wrinkle test - ANS Lack or wrinkling correlating with denervated hand Good for use with children Ninhydrin Test - ANS Assessing for fingerprints on bond paper If fingertips don't sweat and leave prints, indicates denervated hand Moberg pick up test - ANS timed test involving picking up, holding, manipulating, and identifying small objects - used with children and cognitively impaired adults Purdue Pegboard - ANS Timed, standardized test with validity and reliability Fine coordination Placing metal pins into a pegboard followed by a washer and collar Minnesota Rate of Manipulation Test - ANS Gross motor coordination test that addresses bilateral turning and placing Phalen's test - ANS passive wrist flexion for 15-60 seconds, positive reproduces numbness and tingling in median nerve distribution Reverse Phalen's Test - ANS passive wrist extension for 15-60 seconds, positive test produces numbness and tingling in median nerve distribution Carpal Compression Test - ANS compression over proximal edge of carpal ligament, positive test produces paraesthesia in median nerve distribution Tinel's sign - ANS percussion over site of possible nerve entrapment CMC Grind test - ANS tests for CMC OA, axial pressure applied with rotation Froment's sign - ANS motor sign of ulnar neuropathy (adductor pollicis) Positive = significant IP flexion when pinching a piece of paper Jeanne's sign - ANS motor weakness in adductor pol Positive = extreme hyperextension of thumb MCP when pinching piece of paper Wartenberg's sign - ANS motor sign for ulnar nerve function specifically 3rd palmar interossei Positive = patient unable to actively adduct 5th finger Ulnar Fovea Sign - ANS detects foveal disruptions and or ulnotriqutral ligament injuries Positive = pressure in interval between ulnar styloid process and FCU tendon, pain reproduced Piano key test - ANS stabilize radius with one hand- with 2nd hand press volarly on ulna and then dorsally- test in BOTH pronation and supination, compare to other side + = "spring back" reaction of the ulna + = DRUJ instability Ballottment sign - ANS tests for stability between lunate and triquetrum Positive = pain, clicking, or laxity when lunate is stabilized and examiner displaces triquetrum dorsally