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Arm Exam Flashcards

1
Q

Visual inspection of arm includes:

A
  • Carrying angle
  • Resting flexion angle of elbow
  • Resting position of supination/ pronation at the forearm
  • Resting position of hand (duprenes: flexed finger)
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2
Q

What tests to rule out more proximal contributors?

A

ULTT, Wright Test, Thoracic Slump

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3
Q

Elimination test for Cubital Tunnel Syndrome?

A

Pressure Provocation Test

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4
Q

Elimination test for Fracture at elbow?

A

Elbow Extension, Flexion, Supination, Pronation Tests

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5
Q

Elimination test for biceps tear?

A

Biceps Squeeze Test

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6
Q

Elimination test for elbow instability?

A

Moving Valgus Stress Test
Varus Stress Test (LCL)
Valgus Stress Test (MCL)

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7
Q

Elimination test for thumb instability?

A

Ulnar Collateral Ligament Test

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8
Q

Elimination test for DeQuervain’s Tenosynovitis?

A

Finkelstein’sTest

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9
Q

Elimination test for Scaphoid Fracture?

A

Anatomic Snuffbox Tenderness

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10
Q 
Elbow extension/flexion/supination/pronation elimination test: 
Indications - 
Pt Position - 
Procedure - 
Positive test-
A

Indications - elbow fracture
Pt Position - supine, supinated forearm
Procedure - Pt instructed to fully extend the elbow
Positive test- Inability compared to contralateral UE

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11
Q 
Pressure provocation elimination test:
Indication - 
Pt Position - 
Procedure - 
Positive test-
A

Indication - cubital tunnel syndrome
Pt Position - sitting/standing
Procedure - Supporting UE at distal wrist, place the patient’s elbow in 20° of elbow flexion & full supination
Apply pressure just proximal to the cubital tunnel & hold 1 minute
Positive test- Provocation of concordant symptoms along the ulnar nerve distribution

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12
Q 
Biceps squeeze elimination test:
Indications - 
Pt Position - 
Procedure - 
Positive test-
A

Indications - biceps tear
Pt Position - Sitting, UE resting in lab with ~60-80° elbow flexion & slight pronation
Procedure - With one hand at the myotendinous junction and the other at the biceps muscle belly, use both hands to squeeze the biceps
Positive test- no passive supination observed

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13
Q 
Moving valgus elimination stress test:
Indications - 
Pt Position - 
Procedure - 
Positive test-
A

Indications - elbow instability
Pt Position - upright, shoulder abducted 90 (support mid-upper arm), elbow fully flexed (clinician grab wrist)
Procedure - Apply valgus torque as shoulder reaches full external rotation -> Quickly extend elbow to 30° while maintaining valgus torque at elbow
Positive test- medial elbow pain provocation from 120-70° flexion

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14
Q

T/F Moving valgus elimination stress test is very provocative.

A

True

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15
Q 
Varus stress elimination test:
Indications - 
Pt Position - 
Procedure - 
Positive test-
A

Indications - Compromise to structural integrity of LCL
Pt Position - sitting, forearm supinated & elbow extended
Procedure - Stabilize the patient’s wrist between your trunk and proximal upper arm -> Grasp the patient’s distal upper arm with both hands -> Apply varus force to elbow Repeat in 20-30° of flexion
Positive test- elbow pain provocation

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16
Q 
Valgus stress elimination test:
Indications - 
Pt Position - 
Procedure - 
Positive test-
A

Indications - Compromise to structural integrity of MCL
Pt Position - sitting, forearm supinated & elbow extended
Procedure - Stabilize the patient’s wrist between your trunk and proximal upper arm -> Grasp the patient’s distal upper arm with both hands -> Apply valgus force to elbow Repeat in 20-30° of flexion
Positive test- elbow pain

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17
Q 
Ulnar collateral lig elimination test:
Indications - 
Pt Position - 
Procedure - 
Positive test-
A

Indications - gamekeeper’s thumb
Pt Position - sitting
Procedure - stabilize 1st MC with pincer grip -> grasp proximal phalanx of the 1st digit with other hand -> extend patient thumb -> apply valgus stress to MCPJ
Positive test- valgus > 30

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18
Q

Positive Ulnar collateral lig elimination test indicates what?

A

Complete tear

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19
Q 
Finkelstein's Elimination test:
Indications - 
Pt Position - 
Procedure - 
Positive test-
A

Indications - de Quervain’s Tenosynovitis
Pt Position - sitting, grasping ipsilateral thumb
Procedure - can passively take through procedure first -> patient then adducts wrist
Positive test- Pain over APL/ EPB tendons

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20
Q 
Anatomic Snuffbox Tenderness elimination test:
Indications - 
Pt Position - 
Procedure - 
Positive test-
A

Indications - scaphoid fracture
Pt Position - sitting
Procedure - Apply pressure to the anatomic snuff box
Positive test- pain/tenderness

21
Q

What is a positive neurodynamic tension test?

A
  1. Concordant symptom reproduction

2. Response altered by movement of distant body part

22
Q

neurodynamic tension test: median bias steps

A
  1. Scapular depression
  2. Shoulder abduction to 110°
  3. Forearm supination
  4. Wrist/ hand extension (digits 1-3)
  5. Shoulder ER
  6. Elbow extension
23
Q

neurodynamic tension test: radial bias steps

A
  1. Scapular depression
  2. Forearm pronation
  3. Elbow Extension
  4. Wrist/ and finger flexion
  5. Shoulder IR
  6. Shoulder slight extension
  7. Shoulder abduction
24
Q

neurodynamic tension test: ulnar bias steps

A
  1. Scapular depression
  2. Shoulder abduction to 110°
  3. Shoulder ER
  4. Elbow Flexed
  5. Forearm pronation
  6. Wrist/ hand and extension
  7. Flex towards head
25
Posterior humero-ulnar glide: | Patient position -
- Supine - Approximately 70° elbow flexion, 10° supination - Shoulder abducted such that humero-ulnar joint line aligns with the edge of the table
26
Posterior humero-ulnar glide: | Examiner position -
- Facing caudally - The more medial hand stabilizes the distal upper arm, & the index finger palpates between the lateral epicondyle & the olecranon - The proximal forearm may be supported by the anterior thigh (supporting the flexed position)
27
Posterior humero-ulnar glide: | Procedure -
Apply traction/ posterior force with hand that is grasping the proximal ulna
28
Anterior & Posterior Humero-Radial Glides: | Patient position -
Supine | Elbow extended & forearm supinated
29
Anterior & Posterior Humero-Radial Glides: | Examiner position -
- Facing cranially - Stabilize the ulna & proximal humerus with the more medial hand - Palpating finger: posterior radiohumeral jointline
30
Anterior & Posterior Humero-Radial Glides | Procedure -
Apply an anterior or posterior force with hand that is purchased on radial head
31
Proximal Radio-Ulnar Anterior & Posterior Glide: | Patient position -
- Sitting next to table (at chest height) | - Arm resting on table, elbow flexed ~ 70°, supinated ~35°
32
Proximal Radio-Ulnar Anterior & Posterior Glide: | Examiner position -
- Facing pt’s posterior forearm | - Stabilize the ulna on the table, and use the stabilizing hand to maintain forearm positioning
33
Proximal Radio-Ulnar Anterior & Posterior Glide: | Procedure -
Apply anterior or posterior force with mobilizing hand that is purchased on radial head
34
Anterior & Posterior Distal Radio-Ulnar Glide: | Patient position -
- Sitting next to table (at chest height) | - Arm resting on table, 10° supination
35
Anterior & Posterior Distal Radio-Ulnar Glide: | Examiner position -
- Stabilize the distal ulna & palpate posterior distal radio-ulnar joint - Mobilizing hand grasping distal radius
36
Anterior & Posterior Distal Radio-Ulnar Glide: | Procedure -
Apply anterior or posterior force on distal radius
37
Confirmation test for cubital tunnel syndrome?
- Elbow Flexion Test | - Tinel’s Sign
38
Confirmation test for medial epidconylopathy?
TRICK QUESTION, there is none
39
Confirmation test for Lateral Epicondylopathy?
- Cozen’s Test - Resisted Tennis Elbow Test - Passive Tennis Elbow Test
40
Confirmation test for Carpal Tunnel Syndrome?
- Phalen’s Test - Tinel’s Test - Median Nerve Compression Test
41
``` Elbow flexion confirmation test: Indication - Patient position - Procedure - Positive test - ```
Indication - Cubital tunnel syndrome Patient position - sitting Procedure - Patient fully flexes elbows and extends wrists -> Pt monitored for symptoms over 3 minutes Positive test - pain/ paresthesia, anesthesia along ulnar nerve distribution
42
``` Tinel's sign confirmation test: Indication - Patient position - Procedure - Positive test - ```
Indication - Cubital tunnel syndrome Patient position - upright Procedure - support wrist -> percuss cubital tunnel 4-6x with finger Positive test - reproduction of symptoms along ulnar nerve distribution
43
``` Cozen's confirmation test: Indication - Patient position - Procedure - Positive test - ```
Indication - Lateral Epicondylopathy (tendinopathy of wrist/finger extensors) Patient position - sitting, elbow flexed to 90°, making fist, wrist in pronation & radial deviation Procedure - support elbow with thumb on lateral epicondyle -> Patient extends fist against clinician’s resistance Positive test - pain reproduction at lateral epicondyle
44
``` Resisted Tennis Elbow Confirmation Test (Maudsley test): Indication - Patient position - Procedure - Positive test - ```
Indication - Lateral Epicondylopathy Patient position - sitting Procedure - Pt extends the 3rd digit against resistance Positive test - pain reproduction at lateral epicondyle
45
``` Passive Tennis Elbow Confirmation Test (mill’s test): Indication - Patient position - Procedure - Positive test - ```
Indication - Lateral Epicondylopathy Patient position - sitting Procedure - Pt’s elbow passively extended -> Examiner pronates forearm & flexes wrist Positive test - pain reproduction at lateral epicondyle
46
``` Phalen's confirmation test: Indication - Patient position - Procedure - Positive test - ```
Indication - Carpal Tunnel Syndrome Patient position - sitting Procedure - Pt holds forearms vertically & drops wrists into full flexion against each other x 60 seconds Positive test - symptom reproduction along median nerve distribution
47
``` Tinel's Confirmation test: Indication - Patient position - Procedure - Positive test - ```
Indication - Carpal Tunnel Syndrome Patient position - sitting, supinated wrist, elbow flexed Procedure - Carpal tunnel percussed with clinician’s finger 4-6x Positive test - symptom reproduction along median nerve distribution
48
``` Median Nerve compression confirmation test: Indication - Patient position - Procedure - Positive test - ```
Indication - Carpal Tunnel Syndrome Patient position - sitting with forearm supinated Procedure - grasping wrist with thumbs over carpal tunnel (between flexor carpi radialis & palmaris longus) -> Pressure applied to carpal tunnel x 15 sec – 2 min Positive test - symptom reproduction along median nerve distribution
49
What is a performance measure for grip strength?
Jamar hand dynamometer

MSK (18 decks)

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