Anatomy and PE of the Upper Extremities Lecture Powerpoint Flashcards
__ joint is the only bony attachment of the upper extremity to the axial skeletal
Sternoclavicular joint
Coracoclavicular and acromioclavicular ligaments
2 ligaments that attach the clavicle to the scapula
For full 180 degree elevation of the humerus, 120 degrees is done at this joint and 60 at this (scapulothoracic rhythm, 2:1 ratio between them with early stage being elevation from the first, intermediate transition, and end stage motion primarily from the second)
Glenohumeral, scapulothoracic
3 components that provide stability to a oint
- structure
- ligaments
- musculature
4 components of the rotator cuff
Supraspinatus
Infraspinatus
Teres minor
Subscapularis
Coracoacromial arch
Ligament that creates a hood between the coroacoid and acromion process, problematic if humerus rides high and migrates superiorally and hits against it causing shoulder impingement syndrome
Sulcus sign
Test for glenohumeral instability in the shoulder, when elbow is grasped and forced downward see depression form just below the acromion
Winging of scapula
Have patient push against the wall and see scapula wing out indicative of….
Apley’s scratch test
Quick assessment of shoulder range of motion by having patient reach behind them and scratch their back in a stereotypical manner
Apprehension test
Test glenohumeral joint anterior instability by having arm abducting and externally rotated, then apply force posteriorly and watch for apprehension
Relocate release test
Done if positive apprehension test to test glenohumeral joint anterior instability by abducting and externally rotating arm then applying force posteriorally and with the other hand blocking off anterior motion of the shoulder, then release and should see apprehension return
Load and shift test
Test for anterior and posterior glenohumeral joint instability, stabilize shoulder joint and apply anterior or posterior translation for laxity
Speeds test
Resisted glenohumeral flexion while elbow is extended testing for pressure over biceps tendon, pain indicates biceps tendon pathology
Drop arm test
Tests for rotator cuff lesion, patient abducts arms to 90 degrees, lowers them slowly, examiners taps the arms forcing them into adduction, pain or instability to resist the tap indicates pathology
Empty can test
Test for supraspinatous rotator cuff lesion, eximiner resists shoulder abduction while arms are in scapular plane with thumb pointed down as though emptying a can
Neer impingement test
Test for shoulder impingement by forcing patients arm flexed jamming the greater tuberocity against the acromion process, pain and or apprehension is posiive
Shoulder impingement mechanism of action
- deltoids raise shoulder and are resisted by rotator cuff muscles
- if weak or torn will see humerus head roll unapposed superiorally hitting the nerves and vessels going under the coracoacromial arch
Allens test
Test for thoracic outlet syndrome where arm is abducted and externally rotated and then the pulse is monitored while the patient turns head away, positive is pulse weakening
Halstead maneuver
Test for thoracic outlet syndrome where arm is extended and externally rotated, pulse is monitored while patient extends neck and turns head away
Adson’s maneuver
Test for thoracic outlet syndrome where arm is extended and externally rotated, pulse is monitored while patient turns head toward arm and holds a deep breath while arm is further extended and externally rotated and pulse weakening in this case is positive
Nursemaid elbow
Dislocation of head of the radius in children often seen by pulling children by the wrist, can be fixed easily with reduction
Ulnar collateral ligament injuries
-result of valgus force or repetitive trauma, causes pain along the medial aspect of the elbow and tenderness with associated paresthesia and positive tinels sign (median nerve nearby)
Ulnar collateral ligament tear treatment (2)
- conservative, will never return to full performance
- ulnar collateral ligament replacement (tommy john procedure) often done in throwers who need that ability
Lateral epicondylitis
tennis elbow, repetitive microtrauma to insertion of extensor muscles of the lateral epicondyle, tendinosis with degeneration of tendon, see aching pain in lateral epicondyle after activity
Medial epicondylitis
Golfers elbow, repeated forceful flexion of wrist and extreme valgus torque of elbow causing pain with forceful flexion or extension, point tenderness and mild swelling, with passive movement of wrist seldom eliciting pain but active movement eliciting it strongly
Medial and lateral epicondylitis tests
Resist wrist flexion or extension (medial or lateral respectively) and put pressure on tendon
Little league elbow
Caused by repetitive microtraumas that occur from throwing, may result in numerous disorders of growth in the pitching elbow
Colle’s fracture
Fracture that occurs in the distal radius or ulna often from FOOSH, see forward displacement of radius causing visible deformity, possibility of tearing tendons causing median nerve damage
Tenosynovitis and management
Inflammation of the synovium surrounding a tendon, most often in the wrist and because of repetitive wrist accelerations and decelerations or repetitive overuse of wrist tendons and sheaths, see pain with use or associated with passive stretching, managed with ice and NSAIDS
Scaphoid fracture
Often caused by force on outstretched hand and often fails to heal due to poor blood supply, presents like a wrist sprain but sees severe pain in anatomical snuff box and pain with radial flexion
Wrist ganglion and management
Synovial cyst from herniation of joint capsule that generally appears after a wrist strain most often on the dorsum of the wrist and may be soft, rubbery, or hard, can be aspirated or removed
Mallet finger and management
Caused by blow that contacts tip of finger avulsing extensor tendon at the DIP resulting in inability to extend distal end of finger, managed with splinting
Boutonneire deformity and management
Swelling of PIP flexion and extension of DIP from inflammation in PIP joints occurring in rheumatoid arthritis, can also be traumatic in origin, managed with splinting
Swan neck deformity and management
Hyperextension of PIP and flexion of DIP joints causing rheumatoid arthritis, managed with splinting
Jersey finger and management
Rupture of flexor digitorum profundus tendon from insertion on distal phalanx resulting in DIP that cannot be flexed and finger remains extended, must be surgically repaired
Dupuytren’s contracture
Nodule development on palmar aponeurosis limiting finger extension causing flexion deformity often 4th or 5th digit,
