cas upper limbs Flashcards
what is the pectoral girdle
e includes the clavicle and the scapula
is the “Scapulothoracic” Joint a real joint
nope, It is a physiological (functional) joint.
pronation bonw chnages
when the hand is turned round so that the palm faces backwards, the radius rotates around in front of the ulna to lie diagonally across it
Wrist (radiocarpal) Joint
movements
Main movements at this joint are flexion, extension, adduction (ulnar deviation) and abduction (radial deviation) of the hand.
Scapulothoracic movement
elevation depression, protraction depression,
and rotation of scapula
glenohumural joint
flexion extension, abduction adduction
medial and lateral rotation
elbow
extension flexion
proximal distal radio-ulnar joint
pronation and supination
wrist
flexion extension
abd and add
midcarpal intercarpal
flexion extention
abd add
carpometacarpal of thumb
flexion extension
add abd
cmc of 2nd 3rd digits
no movement
4th and 5th digit
restricted movement
intermetacarpal
very restrcited sliding movement
metacarophalangeal
thumb flex exten
2 5th flex exten abd add
interphalangeal
flex exten
scapulothoracic joint elevation
shrug your shoulders
scapulothoracic joint
depression protraction
shoulders down and out
retraction
back
glenohumeral joint flexion
arm up
extension
back behind you
abd
up to the side making a 1/4 circle
internal rotation
cradle a baby shape
external rotation
|-
circumduction
put your arms up to the side and make circles
elbow joint flexion
put your forearm up as if doing weights
extension
arm/forearm down by your side
radioulnar joint pronation
down
supination
up
wrist joint flexion
wrist up
extension
wrist down
adduction
wrist towards chest
abduction
wrist other way
Some general rules are applicable to the examination of joints. They are:
Look – visual inspection Feel - palpation Move – range of passive movements Measure – measure the degrees of movement Compare with the opposite limb.
ALWAYS
ask the patient if they have any PAIN prior to palpation and passive movement
assessment of passive joint movement
ask patient to completely relax theiir arm (flop)
passivley circumduct the shoulder joint to detect stiffnes or reduced joint
same with other joint
passively flex and extend the elbow to detect stiffnes or reduced in tone and then other arm
pass supinate and pronate
looking for same things
and flex extend wrist
both wrists
Reduced tone (hypotonia)
If there is a breach/disruption in the spinal segmental reflex arc and the simple spinal reflexes are not functioning, the muscle will be without any tone, it will be fully relaxed and you will experience hypotonia, in keeping with a Lower Motor Neurone (LMN) problem/lesion.
Increased tone (hypertonia)
The lower motor neurons of the spinal segmental neurons are influenced by nervous impulses received from the cerebral cortex, midbrain, pons and medulla. These supra spinal neurons are called Upper Motor Neurons (UMN). The impulses from the upper motor neurons have an inhibitory effect on the lower motor neurons.
If the higher cerebral control is disrupted, as in an UMN lesion/problem, the inhibition is lost and the muscle tone is exaggerated you will experience hypertonia (sometimes spasticity).
what is A prime mover (or an agonist)
the main muscle responsible for producing a specific movement of the body part.
“Scapulothoracic” joint
elevation prime mover
Superior trapezius!, levator scapulae, rhomboids
Depression
gravity!
Inferior trapezius, pectoralis minor, serratus anterior
Protraction
serratus anterior
retraction
trapezius middle part
upward rotation
trapezius descending part
serratus anterior inferior part
downwards rotation
lattisumus dorsi
The muscles acting on the glenohumeral joint are also
intrinsic shoulder muscles
these are
four rotator cuff muscles that give stability to the shoulder joint. They are supraspinatus, infraspinatus,teres minor and subscapularis muscles.
how to test exterior muscle of shoulder the
serratus anterior
ask the patient to put arms against the wall
feel the contraction on the lateral thoracic wall
test the latissum dorsi
arm up to the side
feel the contraction behinfd the shoulder
trapezius
feel the contraction when providing resistance against elevation of the shoulders
deltoid
arm to the side
the top arm part
supraspintus
arm to the side
feel contraction above scapular spine
infraspinctus and teres minor
feel the contraction below the scapula spine
make forearm and shoulder perpendicular
subscapularis
cant feel contraction as in the anterior scapula
ask patinet to push your hand with the side of theirs
while they move their arm inward
pectoralis major
ask them to bring arms down
to their side
feel contraction at the top arm
branchialis and biceps branchi
ask them to bring elbow up
resist
contraction on anterior arm
tricep branchii
ask them to slightly bind elbow then ask to straight
feel contraction on posterior arm
pronator teres and pronator quadratus
palm to ceiling then downwards
feel contraction of pronator teres on anterior forearm
There is a 0 to 5 rating scale for muscle strength:
0/5: no movement
1/5: Barest flicker of movement of the muscle, though not enough to move the structure to which it’s attached
2/5: Voluntary movement which is not sufficient to overcome the force of gravity. For example, the patient would be able to slide their hand across a table but not lift it from the surface
3/5: Voluntary movement capable of overcoming gravity, but not any applied resistance. For example, the patient could raise their hand off a table, but not if any additional resistance were applied
4/5: Voluntary movement capable of overcoming “some” resistance
5/5 Normal strength
‘+’ and ‘-‘ can be used indicate more subtle descriptions of power (e.g., 4+ or 4- , 3+ or 3-, etc.
