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A 22-year-old male patient presents with surgical repair (eight weeks post) of the extensor tendons of his right hand following an accident at work. The patient's right hand and arm are in a sling and the prescription from the surgeon reads ‘PT: evaluate and treat -- begin gentle passive range of motion exercises’. When you ask the patient whether he can move his fingers at all, you notice only a small amount of motion occurs.

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Would you perform a manual muscle test of the patient's right-hand?

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Manual muscle testing of the patient's right-hand is not appropriate at this time because the physician ordered passive range of motion only.

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Would you assess the patient's right wrist, elbow, and shoulder range of motion?

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Checking the range of motion of the right upper extremity is indicated

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Are there any other questions you would ask this patient before beginning your physical examination?

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It would be important to know if the patient is right or left-handed, his pain levels, and whether he has noticed any changes in sensation.

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In addition to the range of motion measurement, what else would you assess with this patient?

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It would be important to get girth measurement at the wrist and fingers, the patient's goals, and to discuss the frequency and duration of your intervention.

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What is the biggest concern when treating a patient following a tendon repair?

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Describe the various tendon gliding exercises you would prescribe and the precautions for each.

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What methods could you use to help control edema? Describe each.

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What activities and positions would you advise the patient to avoid? Why?

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Estimate this patient’s prognosis in terms of number of visits required.

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What electrotherapeutic modalities could you use in the intervention of this patient? Why?

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Which manual techniques might be appropriate for this patient, and what is your rationale for each?

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What upper kinetic chain exercises would you prescribe? Why?

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