Chapter 7 - Upper Extremity Flashcards
Rotator cuff muscles (w/ function)
Supraspinatus (abduction)
Infraspinatus (ER)
Teres minor (ER)
Subscapularis (IR)
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
Subclavian artery vs. vein - anatomy in neck
Artery = between anterior and middle scalene Vein = anterior to anterior scalene
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
What artery runs with the radial nerve in the radial groove?
Profunda brachii artery
Where does the brachial artery bifurcate into the radial and ulnar?
Bicipital aponeurosis (under it)
Deep palmar arch - via what artery?
Superficial palmar arch - via what artery?
Radial artery
Ulnar artery
Order of treatments to relieve lymph in UE (3)
- Thoracic inlet
- Re-dome diaphragm
- Posterior axillary fold technique
Abduction of the arm - what joints contribute?
2/3 = glenohumeral (2 of every 3 degrees) 1/3 = scapulothoracic (1 of every 3 degrees)
MC shoulder dysfunction
Restriction to IR and ER
IR and ER of the shoulder…clavicle movement?
Rotation around a transverse axis
MC SC joint dysfunction
Restrictions?
Anterior and superior clavicle on the sternum
- Restricted to shoulder elevation and protraction
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
3 places for thoracic outlet syndrome
- Between anterior and middle scalenes
- Between clavicle and first rib
- Between the pec minor and upper ribs
Positive Adson’s test = ?
Positive Military posture test = ?
Positive Hyperextension test = ?
Between scalenes
Between clavicle and rib 1
Under pec minor
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)
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
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
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)
- Rib and upper thoracic (decrease SNS in UE)
- Cervical and MFR (increase brachial plexus fxn)
- Direct release to flexor retinaculum (increase space)
OMT for lateral or medial epicondylitis (3) (w/ goals)
- Cervical or upper thoracics (SNS, brachial plexus)
- Counterstrain to muscles (relaxation)
- 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
