Chapter 16: MSK

Question 1

List the muscles of the rotator cuff (SITS)

Answer 1

Supraspinatous
Infraspinatous
Teres minor
Subscapularis

Question 2

Crossover test

Answer 2

Adduct patient’s arm across chest. Pain suggests inflammation or arthritis of the acrimioclavicular joint (sensitivity 80%, specificity: 50%)

Question 3

Apley scratch test

Answer 3

Rotator cuff disorder or adhesive capsulitis

Question 4

Inflammatory phase of injury

Answer 4

0-3 days

Question 5

Proliferative phase of injury

Answer 5

3-14 days

Question 6

Remodeling phase of injury

Answer 6

14 days - 1 year

Question 7

Capsular limit on ROM

Answer 7

Limited ROM in multiple directions, pain, and different end-feel. Consistent with arthritis.

Question 8

Neer’s Impingement sign

Answer 8

Hold scapula, lift patients straight arm to 180 degrees. Pain suggests inflammation or rotator cuff tear

Question 9

Hawkin’s Impingement sign

Answer 9

Flex patient’s shoulder and elbow to 90 degrees with palm facing down, then rotate the arm internally. Pain suggests rotator cuff tear or inflammation.

Question 10

Supraspinatous strength (empty can test)

Answer 10

Have patient hold out hands as if emptying cans with straight arms. Apply downward pressure to extended arms. If one side is weaker, rotator cuff tear is suggested.

Question 11

Infraspinatous strength

Answer 11

Elbows flexed to 90 degrees, thumbs up, arms at sides. Have patient push outward as you provide resistance at level of forearm. Weakness suggests rotator cuff tear or bicipital tendinitis.

Question 12

Forearm supination test

Answer 12

with patient’s arms flexed at 90 degrees and hands pronated, have patient supinate against resistance. Pain suggests inflammation of long head of biceps and possible rotator cuff tear.

Question 13

Drop-arm sign

Answer 13

Have patient abduct the arm to shoulder level (90 degrees) and lower it slowly. If patient cannot hold it at shoulder level or control lowering, it suggests rotator coff tear.

Question 14

Ulnar nerve passes elbow superficially, over the…

Answer 14

medial epicondyle

Question 15

Heberden’s nodes

Answer 15

Hard dorsolateral nodules on the DIP joints. Involved in osteoarthritis and psoriatic arthritis.

Question 16

Innervation of hand

Answer 16

Dorsal surface: Mostly radial nerve. Median nerve innervates area distal to PIP on fingers 1, 2, 3 and half of 4. Pinky and other half of 4 are ulnar nerve.
Volar surface: (1.5, 3.5): Ulnar fingers 5 and 4. Median Fingers 4, 3, 2, 1. Radial nerve: side of base of thumb.

Question 17

Loss of sensation in carpal tunnel syndrome:

Answer 17

areas innervated by median nerve.

Question 18

Thumb movement test

Answer 18

Hold thumb in fist, then deviate ulnarly. Pain suggests de Quervan’s tenosynovitis from inflammation of abductor policis longus and extensor policis brevis tendons.

Question 19

Thumb abduction test

Answer 19

Have patient abduct thumb against resistance. Weakness suggests carpal tunnel.

Question 20

Tinnel’s sign

Answer 20

Tap lightly over median nerve over course of carpal tunnel. Aching and numbness is positive for carpal tunnel syndrome.

Question 21

Phalen’s test

Answer 21

ask patient to hold wrists in flexion for 60 seconds (backs of hands against one another). Numbness and tingling in the median nerve distribution within 60 seconds is a positive test.

Question 22

Principle arm flexors

Answer 22

Anterior deltoid, pectoralis major

Question 23

Principle arm extendors

Answer 23

Latissimus dorsi, teres major, posterior deltoid

Question 24

Primary arm abductors

Answer 24

Supraspinatus, middle deltoid, serratus anterior (rotates scapula)

Question 25

Primary arm sdductors

Answer 25

Pectoralis major, coracobrachialis, latissimus dorsi, teres major, subscapularis

Question 26

Primary internal rotators of arm

Answer 26

Subscapularis, anterior deltoid, pectoralis major, teres major, latissimus dorsi

Question 27

Primary external rotators of arm

Answer 27

Infraspinatous, teres minor, posterior deltoid

Question 28

Flexors of forearm

Answer 28

biceps, brachialis, and brachioradialis

Question 29

Extensors of forearm

Answer 29

triceps

Question 30

Pronators of forearm

Answer 30

Pronator teres

Question 31

Supinators of forearm

Answer 31

Biceps, supinator

Question 32

Flexors of hand

Answer 32

Flexor carpi radialis, fexor carpi ulnaris

Question 33

Extensors of hand

Answer 33

Extensor carpi ulnaris, extensor carpi radialis longis and brevis

Question 34

McMurray Test

Answer 34

Supine patient. Grasp heel and flex knee. Externally rotate the lower extremity and extend (Medial meniscus). Internal rotation will do the same for lateral mensicus. If a “click” is heard/felt during flexion and extension, suggests a tear of meniscus.

Question 35

radial deviators of hand

Answer 35

flexor carpi radialis

Question 36

ulnar deviators of hand

Answer 36

flexor carpi ulnaris

Question 37

hand grip test (sign)

Answer 37

Positive if you can pull your fingers out. Decreased grip strength is a positive test for weakness of the finger flexors and/or intrinsic muscles of the hand. It may also result from pain from degenerative joint changes.

Question 38

Step-off

Answer 38

When palpating spinous processes (step 1 of palpation of spine) a noticeable difference in prominence of one spinous process vs another. Suggests a slippage of a vertebra. If accompanied by tenderness, then it could be infection or fracture.

Question 39

what causes “winging” of the scapula

Answer 39

loss of innervation of the serratus anterior muscle by the long thoracic nerve

Question 40

major flexors of back

Answer 40

Psoas major and minor, quadratus lumborum, muscles of abdominal wall

Question 41

primary extensors of back

Answer 41

deep intrinsic muscles of back

Question 42

muscles responsible for lateral flexion and rotation of back/trunk

Answer 42

Intrinsic muscles of back, muscles of abdominal wall

Question 43

Abduction (Valgus) stress test

Answer 43

Tests strength of medial collateral ligament (MCL). With leg abducted 30 degrees and slightly flexed, Push medially against knee while pulling ankle laterally. Sign is pain or visible gap.

Question 44

Adduction (varus) stress test

Answer 44

Tests strength of lateral collateral ligament (LCL). Leg abducted at 30 degrees and slightly flexed, pull laterally against knee while pushing medially against angle. Sign is pain or visible gap.

Question 45

Anterior drawer sign

Answer 45

With patient supine, hips flexed and knees flexed to 90 degrees, feet flat on table. With thumbs on medial and lateral joint line, and fingers on the medial and lateral hamstring insertions, pull the tibia forward and see if it slides like a drawer from under the femur. A forward jerk showing the contours of the upper tibia is a postive anterior drawer sign, suggesting DAMAGE TO ACL.

Question 46

Lachman test

Answer 46

also tests ACL. With knee in 15 degrees of flexion and external rotation, grasp distal femur on lateral side with one hand, and proximal tibia with the other. With thumb of the tibial hand on the joint head, simultaneously pull the tibia forward and femur back.

Question 47

Posterior drawer sign

Answer 47

Same as anterior drawer test, except you push the tibia posteriorly and observe for backward movement in the femur. Tests for damage to PCL.