Chapter 7 - Upper Extremity Flashcards by Andrew Herrmann

Rotator cuff muscles (w/ function)

Supraspinatus (abduction)
Infraspinatus (ER)
Teres minor (ER)
Subscapularis (IR)

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Primary flexor of arm
Primary abductor of arm
Primary extensors of arm (3)
Primary adductors of arm (2)

Deltoid (anterior)
Deltoid (middle)
Latissimus, Teres major, Deltoid (posterior)
Pec major, Latissimus

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Subclavian artery vs. vein - anatomy in neck

Artery = between anterior and middle scalene
Vein = anterior to anterior scalene

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When does the subclavian artery become the axillary artery?

When does the axillary artery become the brachial artery?

Lateral border of 1st rib

Inferior border of teres minor

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What artery runs with the radial nerve in the radial groove?

Profunda brachii artery

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Where does the brachial artery bifurcate into the radial and ulnar?

Bicipital aponeurosis (under it)

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Deep palmar arch - via what artery?

Superficial palmar arch - via what artery?

Radial artery

Ulnar artery

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Order of treatments to relieve lymph in UE (3)

Thoracic inlet
Re-dome diaphragm
Posterior axillary fold technique

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Abduction of the arm - what joints contribute?

2/3 = glenohumeral (2 of every 3 degrees)
1/3 = scapulothoracic (1 of every 3 degrees)

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MC shoulder dysfunction

Restriction to IR and ER

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IR and ER of the shoulder…clavicle movement?

Rotation around a transverse axis

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MC SC joint dysfunction

Restrictions?

Anterior and superior clavicle on the sternum

- Restricted to shoulder elevation and protraction

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MC AC joint dysfunction
Restrictions?
Findings?

Superior and lateral clavicle on acromion

Inferior glide at the AC joint
Step-off at AC joint, tenderness at AC joint

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3 places for thoracic outlet syndrome

Between anterior and middle scalenes
Between clavicle and first rib
Between the pec minor and upper ribs

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Positive Adson’s test = ?
Positive Military posture test = ?
Positive Hyperextension test = ?

Between scalenes
Between clavicle and rib 1
Under pec minor

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Pain at acromion, exaggerated by abduction (60-120)

What is this painful range called?

Cause?

Danger?

Supraspinatus tendonitis

“Painful arc”

Impingement of greater tuberosity on acromion w/ arm flexion and internal rotation

Calcification of tendon (chronic)

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Acute supraspinatus tendonitis - treatment

Severe cases?

OMT? Goal?

Rest, ice, NSAIDs

Sling, steroid injection

Shoulder complex, upper thoracics, ribs – free up motion and loosen fascia of shoulder girdle to EXPEDITE HEALING PROCESS

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Bicipital tenosynovitis - tendon?

Result?

Pain?

Aggravation?

Treatments?

Long head of biceps

Adhesions or subluxation

Anterior aspect of humerus at bicipital groove

Resisted flexion and/or supination

Rest, Ice, injection, OMT to glenohumoral, MFR

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Tenderness just below tip of acromion
Sharp pain followed by dull ache for days
Weak abduction

Positive tests?
Common sign?
Pain especially when?

Rotator cuff (esp. supraspinatus) tear

Positive drop-arm test, empty can test

Atrophy is common

Pain especially at night

Pain and restriction of shoulder, gets worse over a year
Decreased ROM, especially ABD, IR, and ER
Pain at end of ROM

Cause?
Pain location?
Treatment?

Adhesive capsulitis (Frozen shoulder syndrome)

Prolonged immobility of shoulder

Anterior portion of shoulder

PREVENTION, Spencer techniques, GH and thoracic Tx’s

MC location of shoulder dislocation

Injury risk?

Anterior and inferior

Axillary nerve

Winging of scapula - issue?

Long thoracic nerve

MC brachial plexus injury during childbirth

Erb-Duchenne palsy (C5-C6)

MC nerve injury in UE via direct trauma

2 causes?

Radial n

Crutch palsy (axilla)
Middle humerus fracture

Carpal bones

Scaphoid, Lunate, Triquetral, Pisiform | Hamate, Capitate, Trapezoid, Trapezium

Only wrist flexor NOT innervated by median nerve

Flexor carpi ulnaris (ulnar nerve)

Supination (2 mm) - nerve? | Pronation (2 mm) - nerve?

Radial n. | Median n.

Only thenar eminence muscle NOT innervated by median nerve

Adductor pollicis (ulnar nerve)

PIP flexion - muscle? | DIP flexion - muscle?

Flexor digitorum superficialis | Flexor digitorum profundus

Carrying angle - how to measure? Normal values?

Line along Humerus Line along Radius/Ulna ``` Men = 5 degrees Women = 10-12 degrees ```

Carrying angle > 15 degrees Carrying angle under 3 degrees

Cubitus valgus (abduction SD of ulna) Cubitus varus (adduction SD of ulna)

Increased carrying angle = ___ of the wrist Decreased carrying angle = ___ of the wrist

Adduction Abduction

Abduction dysfunction of ulna --> issue w/ radial head?

Compression against lateral humeral condyle

Adduction dysfunction of ulna --> issue w/ radial head?

Distraction from lateral humeral condyle

Falling forward on pronated forearm --> ___ radial head Restrictions? (2)

Posterior Supination of forearm Anterior glide of radial head

Falling backward on supinated forearm --> ___ radial head Restrictions? (2)

Anterior Pronation of forearm Posterior glide of radial head

Gold standard for diagnosis of carpal tunnel

Nerve conduction/electromyography

OMT for carpal tunnel (3) (w/ goals)

1. Rib and upper thoracic (decrease SNS in UE) 2. Cervical and MFR (increase brachial plexus fxn) 3. Direct release to flexor retinaculum (increase space)

OMT for lateral or medial epicondylitis (3) (w/ goals)

1. Cervical or upper thoracics (SNS, brachial plexus) 2. Counterstrain to muscles (relaxation) 3. MFR (decreased restrictions)

Flexion of MCP and DIP Extension of PIP Cause?

Swan-neck deformity RA - contracture of intrinsic hand muscles

Extension of MCP and DIP Flexion of PIP Cause?

Boutonniere deformity RA - rupture of hood of tendon at PIP

Extension of MCP Flexion of PIP and DIP Cause?

Claw hand Median and ulnar nerve injury

Extension of MCP Flexion of PIP and DIP Atrophy of thenar eminence Adduction of thumb Cause?

Ape hand Median nerve damage

Contracture of fingers 4-5 Atrophy of hypothenar eminence Cause?

Bishops deformity (Pope's blessing) Ulnar nerve damage

Permanent contracture of MCP and PIP of fingers 4-5 Cause?

Dupuytren's contracture Contracture of palmar fascia