● 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, elbow flexed at 90 degrees, and forearm in neutral; client instructed to squeeze dynamometer as pictured (Figure 8; MacDermid, 2015). FIGURES 8a-b: STRENGTH MEASUREMENTS Figure 8a: Using a Dynamometer
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 (Figure 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 rheumatoid arthritis is not necessarily found in OA. Typical joints affected by rheumatoid arthritis include the MCPs, wrists, elbows, shoulders, and ankles, often in a symmetrical pattern not always seen in OA. During range of motion testing and other functional assessment 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. density (that appears white on film), new bone cell formation, marginal bony growths (i.e., bone spurs), or joint subluxation can be helpful when there is a diagnostic question (Khorashadi et al.,2012).
Source: Erin Peterson
● Palpation should be done for any other swelling that might be present, such as in the palmar fascia (Figure 9).
Radiology Diagnosis of OA of the hands and wrist is determined primarily by clinical presentation. However, radiological tests can confirm a diagnosis in questionable cases, and are helpful in ruling out other conditions. Plain x-rays showing the presence of asymmetric joint space narrowing, increased subchondral
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Book Code: PTOH1324
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