cas upper limbs

Question 1

what is the pectoral girdle

Answer 1

e includes the clavicle and the scapula

Question 2

is the “Scapulothoracic” Joint a real joint

Answer 2

nope, It is a physiological (functional) joint.

Question 3

pronation bonw chnages

Answer 3

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

Question 4

Wrist (radiocarpal) Joint

movements

Answer 4

Main movements at this joint are flexion, extension, adduction (ulnar deviation) and abduction (radial deviation) of the hand.

Question 5

Scapulothoracic movement

Answer 5

elevation depression, protraction depression,

and rotation of scapula

Question 6

glenohumural joint

Answer 6

flexion extension, abduction adduction

medial and lateral rotation

Question 7

elbow

Answer 7

extension flexion

Question 8

proximal distal radio-ulnar joint

Answer 8

pronation and supination

Question 9

wrist

Answer 9

flexion extension

abd and add

Question 10

midcarpal intercarpal

Answer 10

flexion extention

abd add

Question 11

carpometacarpal of thumb

Answer 11

flexion extension

add abd

Question 12

cmc of 2nd 3rd digits

Answer 12

no movement

Question 13

4th and 5th digit

Answer 13

restricted movement

Question 14

intermetacarpal

Answer 14

very restrcited sliding movement

Question 15

metacarophalangeal

Answer 15

thumb flex exten

2 5th flex exten abd add

Question 16

interphalangeal

Answer 16

flex exten

Question 17

scapulothoracic joint elevation

Answer 17

shrug your shoulders

Question 18

scapulothoracic joint

depression protraction

Answer 18

shoulders down and out

Question 19

retraction

Answer 19

back

Question 20

glenohumeral joint flexion

Answer 20

arm up

Question 21

extension

Answer 21

back behind you

Question 22

abd

Answer 22

up to the side making a 1/4 circle

Question 23

internal rotation

Answer 23

cradle a baby shape

Question 24

external rotation

Answer 24

|-

Question 25

circumduction

Answer 25

put your arms up to the side and make circles

Question 26

elbow joint flexion

Answer 26

put your forearm up as if doing weights

Question 27

extension

Answer 27

arm/forearm down by your side

Question 28

radioulnar joint pronation

Answer 28

down

Question 29

supination

Answer 29

up

Question 30

wrist joint flexion

Answer 30

wrist up

Question 31

extension

Answer 31

wrist down

Question 32

adduction

Answer 32

wrist towards chest

Question 33

abduction

Answer 33

wrist other way

Question 34

Some general rules are applicable to the examination of joints. They are:

Answer 34

``` Look – visual inspection Feel - palpation Move – range of passive movements Measure – measure the degrees of movement Compare with the opposite limb. ```

Question 35

ALWAYS

Answer 35

ask the patient if they have any PAIN prior to palpation and passive movement

Question 36

assessment of passive joint movement

Answer 36

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

Question 37

Reduced tone (hypotonia)

Answer 37

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.

Question 38

Increased tone (hypertonia)

Answer 38

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).

Question 39

what is A prime mover (or an agonist)

Answer 39

the main muscle responsible for producing a specific movement of the body part.

Question 40

“Scapulothoracic” joint | elevation prime mover

Answer 40

Superior trapezius!, levator scapulae, rhomboids

Question 41

Depression

Answer 41

gravity! | Inferior trapezius, pectoralis minor, serratus anterior

Question 42

Protraction

Answer 42

serratus anterior

Question 43

retraction

Answer 43

trapezius middle part

Question 44

upward rotation

Answer 44

trapezius descending part | serratus anterior inferior part

Question 45

downwards rotation

Answer 45

lattisumus dorsi

Question 46

The muscles acting on the glenohumeral joint are also

Answer 46

intrinsic shoulder muscles

Question 47

these are

Answer 47

four rotator cuff muscles that give stability to the shoulder joint. They are supraspinatus, infraspinatus,teres minor and subscapularis muscles.

Question 48

how to test exterior muscle of shoulder the | serratus anterior

Answer 48

ask the patient to put arms against the wall | feel the contraction on the lateral thoracic wall

Question 49

test the latissum dorsi

Answer 49

arm up to the side | feel the contraction behinfd the shoulder

Question 50

trapezius

Answer 50

feel the contraction when providing resistance against elevation of the shoulders

Question 51

deltoid

Answer 51

arm to the side | the top arm part

Question 52

supraspintus

Answer 52

arm to the side | feel contraction above scapular spine

Question 53

infraspinctus and teres minor

Answer 53

feel the contraction below the scapula spine | make forearm and shoulder perpendicular

Question 54

subscapularis

Answer 54

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

Question 55

pectoralis major

Answer 55

ask them to bring arms down to their side feel contraction at the top arm

Question 56

branchialis and biceps branchi

Answer 56

ask them to bring elbow up resist contraction on anterior arm

Question 57

tricep branchii

Answer 57

ask them to slightly bind elbow then ask to straight | feel contraction on posterior arm

Question 58

pronator teres and pronator quadratus

Answer 58

palm to ceiling then downwards | feel contraction of pronator teres on anterior forearm

Question 59

There is a 0 to 5 rating scale for muscle strength:

Answer 59

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.