● Strength testing should be performed using manual muscle test techniques and/or a handheld dynamometer and pinch meter to determine grip and pinch strength of the hand and fingers. The standard position of the client should be client seated, shoulder at zero degrees flexion and abduction, el- bow flexed at 90 degrees, and forearm in neutral; client in- structed to squeeze dynamometer as pictured (Figure 8; Mac- Dermid, 2015). FIGURES 8a-b: STRENGTH MEASUREMENTS Figure 8a: Using a Dynamometer
● Palpation should be done for any other swelling that might be present, such as in the palmar fascia (Figure 9). Figure 9: Palpating Palmar Fascia
Source: Erin Peterson ● Gentle pressure should be applied simultaneously on two sides (i.e., medial/lateral and/or volar/dorsal) of the joint (Fig- ure 10) to determine the presence of pain or discomfort, which is a positive sign of joint swelling (Cooper, 2020).
Figure 10: Palpating a Joint Using Lateral Pressure
Source: Erin Peterson
Figure 8b: Using a Pinch Meter
Source: Erin Peterson When performing the physical examination, the therapist should remember that the inflammation that is often present in rheuma- toid arthritis is not necessarily found in OA. Typical joints affected by rheumatoid arthritis include the MCPs, wrists, elbows, shoul- ders, and ankles, often in a symmetrical pattern not always seen in OA. During range of motion testing and other functional as- sessment tests of the physical examination, the therapist might observe crepitus as bony surfaces move against each other in the joint. Crepitus is a grinding, grating, clicking, or cracking noise. In the case of OA, crepitus can be heard when the joint or bone ends come together and grind against one another. If crepitus is not accompanied by pain or limitation of movement, it is of no clinical significance.
Source: Erin Peterson
EliteLearning.com/ Physical-Therapy
Book Code: PTCA2624
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