Anatomy and PE of the Upper Extremities Lecture Powerpoint

Question 1

__ joint is the only bony attachment of the upper extremity to the axial skeletal

Answer 1

Sternoclavicular joint

Question 2

Coracoclavicular and acromioclavicular ligaments

Answer 2

2 ligaments that attach the clavicle to the scapula

Question 3

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)

Answer 3

Glenohumeral, scapulothoracic

Question 4

3 components that provide stability to a oint

Answer 4

• structure
• ligaments
• musculature

Question 5

4 components of the rotator cuff

Answer 5

Supraspinatus
Infraspinatus
Teres minor
Subscapularis

Question 6

Coracoacromial arch

Answer 6

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

Question 7

Sulcus sign

Answer 7

Test for glenohumeral instability in the shoulder, when elbow is grasped and forced downward see depression form just below the acromion

Question 8

Winging of scapula

Answer 8

Have patient push against the wall and see scapula wing out indicative of….

Question 9

Apley’s scratch test

Answer 9

Quick assessment of shoulder range of motion by having patient reach behind them and scratch their back in a stereotypical manner

Question 10

Apprehension test

Answer 10

Test glenohumeral joint anterior instability by having arm abducting and externally rotated, then apply force posteriorly and watch for apprehension

Question 11

Relocate release test

Answer 11

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

Question 12

Load and shift test

Answer 12

Test for anterior and posterior glenohumeral joint instability, stabilize shoulder joint and apply anterior or posterior translation for laxity

Question 13

Speeds test

Answer 13

Resisted glenohumeral flexion while elbow is extended testing for pressure over biceps tendon, pain indicates biceps tendon pathology

Question 14

Drop arm test

Answer 14

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

Question 15

Empty can test

Answer 15

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

Question 16

Neer impingement test

Answer 16

Test for shoulder impingement by forcing patients arm flexed jamming the greater tuberocity against the acromion process, pain and or apprehension is posiive

Question 17

Shoulder impingement mechanism of action

Answer 17

• 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

Question 18

Allens test

Answer 18

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

Question 19

Halstead maneuver

Answer 19

Test for thoracic outlet syndrome where arm is extended and externally rotated, pulse is monitored while patient extends neck and turns head away

Question 20

Adson’s maneuver

Answer 20

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

Question 21

Nursemaid elbow

Answer 21

Dislocation of head of the radius in children often seen by pulling children by the wrist, can be fixed easily with reduction

Question 22

Ulnar collateral ligament injuries

Answer 22

-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)

Question 23

Ulnar collateral ligament tear treatment (2)

Answer 23

• conservative, will never return to full performance

- ulnar collateral ligament replacement (tommy john procedure) often done in throwers who need that ability

Question 24

Lateral epicondylitis

Answer 24

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

Question 25

Medial epicondylitis

Answer 25

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

Question 26

Medial and lateral epicondylitis tests

Answer 26

Resist wrist flexion or extension (medial or lateral respectively) and put pressure on tendon

Question 27

Little league elbow

Answer 27

Caused by repetitive microtraumas that occur from throwing, may result in numerous disorders of growth in the pitching elbow

Question 28

Colle’s fracture

Answer 28

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

Question 29

Tenosynovitis and management

Answer 29

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

Question 30

Scaphoid fracture

Answer 30

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

Question 31

Wrist ganglion and management

Answer 31

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

Question 32

Mallet finger and management

Answer 32

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

Question 33

Boutonneire deformity and management

Answer 33

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

Question 34

Swan neck deformity and management

Answer 34

Hyperextension of PIP and flexion of DIP joints causing rheumatoid arthritis, managed with splinting

Question 35

Jersey finger and management

Answer 35

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

Question 36

Dupuytren’s contracture

Answer 36

Nodule development on palmar aponeurosis limiting finger extension causing flexion deformity often 4th or 5th digit,