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 fingers):

1. Inspection:

•    Finger, hand or wrist posturing

•    Redness, swelling, warmth

•    Scars

2. Palpation:

•    Bones

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

3. Mobility:

•  Active and passive ROM (flexion, extension.
abduction and adduction) of fingers and wrist

4. Muscle Testing:

•    Finger - flexors, extensors, intrinsics

•    Wrist - radial and ulnar devialors. extensors and flexors, supinators and pronators

•    Elbow - flexors and extensors

•    Thumb - flexion, extension and opposition

5. Provocation Tests:

•  Ask the client to actively flex and extend their
fingers. A sudden and audible snapping
occurring in one of the fingers indicates a
trigger finger.

6. Neurological Tests:

•  Sensation

7. Other joints:

•  Test other fingers, elbow 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, trigger block splint, stretching, rest, home program activity. or sport re-education for prevention of re-injury. etc.. when appropriate)

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

D.    Plan:

1.     Frequency and duration of treatment

2.  Dates for assessment of progress

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