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Upper Extremity EvaluationSubjective Information
Adam c. Simoes OTR/L, CEAS
Evaluations
I am thinking of something?
The top 10 things Adam asks his patients
• 10 ‐ Do you have any trouble sleeping at night? • 9 ‐ Do you have any hypersensitivity? (RSD)• 8 ‐ Do you have any numbness or tingling?• 7 ‐What relieves your pain? • 6 ‐ Do you have any pain/ activities?• 5 ‐What do you do for work?• 4 ‐ Do you have any medical Hx I need to know about?• 3 ‐When and How did this happen? • 2 ‐ Age• 1 ‐ How can I help you today?
Alternative Questions
• Psychosocial Factors‐ Sudden loss of life, traumatic life experiences.
• Any Shoulder Issues? (ROM, Discomfort)
5 question you would ask that I did not ask
Subjective Information UE andSpecial Tests
Purpose of the Subjective Evaluation
• Chance to listen to our patients
• Guide our Objective Evaluation and Special Tests
Special Tests
De Quervain's
• Finkelstein’s Test‐(EPB,APL)• Eichoff
CMC Arthritis
• Grind Test‐• Painful Gritty• The examiner grasps the thumb metacarpal and places an axial force with grinding. Reproduction of pain is a positive test.
Scaphoid Fracture
• Pain and swelling at base of thumb
• Distal pole‐ volar tenderness/pain
• Waist‐ snuff box tenderness/pain
• Proximal pole‐ distal to Lister’s tubercle
Dupuytren’s Table Top Test• Unable to flatten hand on table.• > 20‐30 MP• Any degree at IP
TFCC Special Tests• Palpation ECU and FCU• Piano Key Test• Ulna load• Supination lift test
Elbow‐ Varus & Valgus Stress Test
• Places stress on the Medial or Lateral Collateral Ligaments of the elbow.
Lateral Epicondylitis CozensTest
• PAIN OVER THE LATERAL EPICONDYLE IS A POSITIVE TEST.
Lateral Epicondylitis Mills Test
• PAIN OVER THE LATERAL EPICONDYLE IS A POSITVE TEST.
Lateral Epicondylitis Maudsley’s Test
• Highly Sensitive Test• Pain at Lateral Epicondyle is Posaitive Test
Medial Epicondylitis Test A
• PAIN OVER THE MEDIAL EPICONDYLE IS A POSITIVE TEST.
Medial Epicondylitis Test B
• PAIN OVER THE MEDIAL EPICONDYLE IS A POSITIVE TEST.
Tinel’s Sign
• Percussion over a nerve• Proximal and Distal• Medial, Radial or Ulna Nerve
• Excessive shooting, electrical or shocking pain along the nerve distribution
Eichoff and FINKELSTEIN'S TEST
• PAIN OVER THE ABDUCTOR POLLICUS LONGUS AND EXTENSOR POLLICUS BREVIS TENDONS IS A POSITIVE TEST. THE 2 SIDES MUST BE COMPARED, BECAUSE THIS TEST IS NORMALLY UNCOMFORTABLE.
Phalen’s Test
• TINGLING IN THE MEDIAN NERVE DISTRIBUTION OF THE HAND IS A POSITIVE TEST.
Modified Phalen’s
• THIS POSITION CAN ELIMINATE INFLUENCE FROM THE THORACIC OUTLET.
Froment’s Sign
• CHECKS FOR ULNAR NERVE DYSFUNCTION (ADDUCTOR POLLICUS WEAKNESS
Cervical Spine Compression
• + if increased radicularpain to one side.
Spurling’s Test
• Pain on that side indicates foraminalencroachment or facet syndrome.
Ganglion Cyst
• Observation• Palpation
Trigger Finger
• Observation• Palpation
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