PATIENT EVALUATION

A.    Subjective:

•    Patient complaint

•    Location

•    Onset and duration of symptoms

•    Description of symptoms (i.e.. numbness. pain [constant, dull, sharp] hypersensitivity. stiffness): use pain scale

•    Pattern of when symptoms occur (AM. PM, after activity, etc.)

•    Self-help or other formal treatment

•    Other medical problems

•    Concurrent medications and allergies

B.     Objective (also compare with uninvolved wrist):

1.  Inspection

•    Hand or wrist posturing

•    Redness, swelling, warmth

•    Scars

2. Palpation:

•    Bony-radial styloid process (anatomic snuffbox) ulna styloid process.

•    Soft tissue: muscles and tendons (laterally. anteriorly, medially, posteriorly).

3. Mobility:

•  Active and passive ROM (flexion, extension.
supination, pronation) of wrist, and thumb flexion.
extension and opposition.

4. Muscle Testing:

•    Wrist radial and ulnar deviators. extensors and flexors, supinators, pronators, elbow flexors and extensors.

•    Thumb flexion, extension, opposition.

5. Provocation Tests:

•  Finkelstein's Test is used to confirm deQuervain's.
The patient makes a fist with the thumb flexed
inside the hand, and then actively ulnar deviates
the wrist. Pain is the indication of a positive test.
The therapist can also do this passively to
determine the presence of deQuervain's.

6. Neurological:

•  Sensation

7. Other Joints:

•  Test elbow, fingers and shoulder for secondary
involvement.

8. Review x-ray films and physician's report

C.     Assessment:

1. Problem list

2.    Goals

3.    Treatment:

 

•    Iontophoresis (medications, dosages, electrode size)

•    Other modalities (e.g., ice or heat, splint, stretch­ing, strengthening, activity or sport re-education to prevent re-injury, etc.)

•    Oral or injectable medications (administered by physician, e.g., NSAIDs, corticosteroids)

D.     Plan:

1. Frequency and duration of treatment

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