B6-043 MSK exam: Upper limb

Question 1

5 P’s of compartment syndrome

Answer 1

pain
pallor
paresthesia
paralysis
pulselessness

Question 2

test for internal rotation of shoulder ROM

Answer 2

hand on back of L spin, reach up

**non dominant side should reach slightly further

Question 3

test for external ROM shoulder

Answer 3

normal is 45-60

Question 4

empty can tests […]

Answer 4

supraspinatus

Question 5

drop arm tests […]

Answer 5

supraspinatus

Question 6

external rotation strength test assesses […]

Answer 6

infraspinatus
teres minor

Question 7

internal rotation lag test (lift off) assesses

Answer 7

subscapularis

Question 8

20% of more loss of strength in the bear hug sign is indicative of […] tear

Answer 8

subscapularis

Question 9

what is this maneuver testing for?

Answer 9

AC joint arthritis or shoulder separation

they will have pain under the examiner’s fingertips

Question 10

adhesive capsulitis patients will have loss of passive […]

Answer 10

external rotation

Question 11

what should your differential include in a patient with loss of passive external rotation? [4]

Answer 11

-adhesive capsulitis
-arthritis
-infection
-dislocation

**RCT is NOT on list because they will maintain passive external rotation

Question 12

what does Speeds test evaluate for?

Answer 12

biceps tendonitis

Question 13

why should you be sure to perform the Speeds test on both shoulders?

Answer 13

can be a tender point in anyone. you’re looking for asymmetric tenderness

Question 14

what is Neer’s test evaluating for?

Answer 14

shoulder inpingement

**this is a passive test, examiner raises arm

Question 15

what is the Hawkins test evaluating for?

Answer 15

shoulder inpingement

**passive test

Question 16

-injury where axon remains intact but may cause affected muscle atrophy
-temporary neuro defect

Answer 16

traction neuropraxia

Question 17

differential for medial elbow pain [3]

Answer 17

cubital tunnel
medial epicondylitits
UCL (athletes-overhead throwers)

Question 18

differential for lateral elbow pain [2]

Answer 18

lateral epicondylitis
radial-capitellar arthritis (much less common)

Question 19

what maneuver can help identify UCL injury with medial elbow pain?

Answer 19

milking maneuver

Question 20

what does this maneuver assess for and what is it called?

Answer 20

lateral epicondylitis

(chair lift test)

Question 21

what does this maneuver assess for and what is it called?

Answer 21

lateral epicondylitis

(middle finger test)

Question 22

“pop” at anterior elbow with eccentric load (i.e. out of truck)

Answer 22

distal biceps tear

Question 23

inability to turn door handle or car ignition may indicate

Answer 23

distal biceps tear

Question 24

why is fixing a distal biceps tear time-dependent?

Answer 24

starts to scar in in 3-4 weeks

Question 25

bump on dorsal or palmar side of wrist that may change in size with activity is likely

Answer 25

ganglion cyst

Question 26

tenderness in the snuffbox may indicate

Answer 26

scaphoid fracture

Question 27

treatment for possible occult scaphoid fracture

Answer 27

put them in splint, reXray a week later

Question 28

what does this maneuver assess for and what is it called?

Answer 28

De Quervains Finkelstein test **pain with ulnar deviation

Question 29

congenital anomaly of a flexed PIP joint

Answer 29

camptodactyly

Question 30

congenital c-shaped curvature of the small finger

Answer 30

clinodactyly

Question 31

congenital webbing of fingers

Answer 31

syndactyly

Question 32

long standing carpal tunnel can cause [...] atrophy

Answer 32

thenar

Question 33

what does this maneuver test for?

Answer 33

FDS (left) and FDP (right) function **check after laceration to hand

Question 34

what does Spurling's sign evaluate?

Answer 34

cervical radiculopathy (see if this induces the arm pain) **passive test

Question 35

what does the shoulder abduction relief sign indicate?

Answer 35

pressure on C5-C6 nerve roots

Question 36

[radiculopathy/myelopathy] is hyporeflexive

Answer 36

radiculopathy

Question 37

[radiculopathy/myelopathy] is hyperreflexive

Answer 37

myelopathy

Question 38

[radiculopathy/myelopathy] has loss of fine motor function

Answer 38

myelopathy

Question 39

[radiculopathy/myelopathy] affects lower motor function

Answer 39

radiculopathy

Question 40

[radiculopathy/myelopathy] affects upper motor function

Answer 40

myelopathy

Question 41

[radiculopathy/myelopathy] may display a wide gait and weakness

Answer 41

myelopathy

Question 42

[radiculopathy/myelopathy] is more urgent

Answer 42

myelopathy

Question 43

positive Hoffman sign

Answer 43

myelopathy

Question 44

supraspinatus injury typically presents at what age?

Answer 44

over 40 **unless acute

Question 45

loss of strength and pain with internal rotation of shoulder

Answer 45

subscapularis injury

Question 46

decreased ROM in abduction and forward flexion with pain and weakness

Answer 46

supraspinatus injury

Question 47

abnormal clicking in shoulder pain with biceps loading (throwing)

Answer 47

SLAP tear

Question 48

swelling, pain with cross chest adduction difficulty lying on affected side trapezial muscle spasms

Answer 48

AC joint arthritis

Question 49

pain over the lateral epicondyle with resisted wrist extension (chair lift test) and resisted middle finger extension

Answer 49

lateral epicondylitis

Question 50

tendon origin implicated in lateral epicondylitis

Answer 50

extensor carpi radialis brevis

Question 51

resisted wrist flexion would test for

Answer 51

medial epicondylitis

Question 52

triangle formed by APL/EPB and EPL tendons

Answer 52

anatomical snuffbox

Question 53

untreated scaphoid fractures with leave patients with

Answer 53

permanent wrist dysfunction (SNAC)

Question 54

what type of splinting is acceptable for possible scaphoid fx?

Answer 54

wrist or thumb spica

Question 55

sensory loss documented before any treatment

Answer 55

primary nerve defecit

Question 56

nerve function is intact prior to and then absent after a procedure or treatment

Answer 56

secondary nerve defecit

Question 57

milder nerve injury due to traction or stretch injury

Answer 57

neuropraxia

Question 58

cyst forming over DIP/PIP that can drain a yellow fluid

Answer 58

mucous cyst

Question 59

can function lost to myelopathy be recovered?

Answer 59

no

Question 60

can function lost to radiculopathy be recovered?

Answer 60

yes

Question 61

[...] reduces risk of stress fracture

Answer 61

cross training

Question 62

treatment for stress fx

Answer 62

decrease loading of the limb until pain is acceptable, slowly return to exercise and switch up exercises