Clinical Signs and Symptoms

Question 1

Signs of arterial insufficiency VS venous insufficiency

Answer 1

Signs of arterial insufficiency include pain, pallor, loss of pulse, sluggish capillary refill, and decreased skin temperature. Signs of venous insufficiency include cyanosis and abnormally quick capillary refill.

Question 2

What is the theory behind the Double-Crush Phenomenon?

Answer 2

Compression of a nerve proximally results in structural and biochemical changes in the cell body and alters axoplasmic flow, thus sensitizing distal sites along the nerve to compressive forces.

Question 3

What are the 4 criteria of true (specific) neurogenic thoracic outlet syndrome (TTOS)?

Answer 3

1) Presence of a cervical rib 2) intrinsic wasting of the hand 3) sensory changes 4) pain or paresthesia over the lower trunk distribution of the plexus.

Question 4

What is the classic clinical presentation of radial tunnel syndrome?

Answer 4

Diffuse dorsal forearm pain and point tenderness 4 cm distal to the lateral epicondyle.

Question 5

What is pronator syndrome now more commonly called?

Answer 5

Proximal Median Nerve Entrapment.

Question 6

What structural changes occur in people with hand-arm vibration syndrome (HAVS)

Answer 6

Chronic exposure can cause thickening of arterial walls, with hypertrophy of individual muscle fibers, demyelination, axonal injury, Schwann cell and fibroblast proliferation, and, ultimately, fibrosis

Question 7

What are two potential sites for entrapment of the suprascapular nerve? What is the clinical significance?

Answer 7

The suprascapular notch which causes weakness to supraspinatus and infraspinatus. Also the spinoglenoid notch which affects only infraspinatus. Suprascapular nerve palsy is common in young athletes who perform overhead smashing motions (volleyball spike)

Question 8

What is the classic clinical presentation of frozen shoulder?

Answer 8

Patients with adhesive capsulitis of the GHJ present with pain and mobility loss at the shoulder, with the hallmark sign being a loss of passive external rotation.. he following objective findings can lead the therapist to the diagnosis of adhesive capsulitis: Loss of GHJ motion of > 25% in at least 2 planes of motion; AROM of the GHJ = PROM of the GHJ; Passive external rotation loss of 50% at the GHJ; Patient has < 30 of external rotation at the GHJ. At no point during the disease process will active range of motion exceed passive range of motion at the GHJ

Question 9

Pain with shoulder elevation >120 that does not improve with greater elevation is indicative of what?

Answer 9

Acromioclavicular joint pathology.

Question 10

What are the clinical signs of spinal accessory nerve palsy?

Answer 10

Limited shoulder elevation and 0/5 middle and lower trapezius strength.

Question 11

Common deformities of RA?

Answer 11

Typical deformity patterns of RA include volar migration and supination of the carpus with ulnar head prominence, MCP joint ulnar drift, and boutonnire and swan-neck deformities of the fingers

Question 12

Describe pain associated with centralized pain mechanism

Answer 12

Pain that is disproportionate, nonlocalized, diffuse, ongoing, and associated with maladaptive behaviors

Question 13

Describe pain associated with nociceptive pain mechanism

Answer 13

Pain that is proportional to the injury, localized, intermittent, sharp with movement, and dull at rest

Question 14

Describe pain associated with neuropathic pan mechanism.

Answer 14

Pain along the nerve distribution with a known history of nerve injury

Question 15

Describe the quadrigia phenomenon.

Answer 15

When this occurs the subject exhibts flexion contracture of the affected digit and decreased flexion force in adjacent digits. It can occur if the FDP is advanced too far in repair.

Question 16

Describe the lumbrical-plus phenomenon

Answer 16

This occurs when the subject attempts to contract the FDP but instead the lumbical is pulled proximally causing IP extension rather than flexion.

Question 17

Describe Egawa’s Sign

Answer 17

A sign of ulnar nerve and interosseous muscle paralysis in which the subject can flex the MF but no deviate it either direction

Question 18

Describe Lindburg’s Sign

Answer 18

An anatomic interconnection of FPL and FDP of the IF. Lindburg’s Syndrome refers to when this results in pain and aggravation with activity. To assess for the sign, actively flex the thumb IP and watch for IF DIP motion.

Question 19

What 3 abnormal positionings of the scapula associated with impingement syndromes?

Answer 19

Decreased upward rotation, increased anterior tilting, increased medial rotation.

Question 20

The disruption of which components of which 2 ligaments can result in a Dorsal Intercalated Segment Instability Pattern (DISI)

Answer 20

The dorsal SL ligament and the volar and dorsal radio scaphocapitate ligament.

Question 21

What are the signs and symptoms of dorsal scapular nerve syndrome? Who is prone to it.

Answer 21

Dorsal scapular nerve syndrome is most commonly caused by a compression of the nerve due to nerve entrapment, often seen in occupations which involve raising the arms over long periods of time (e.g. painters, electricians) and athletes. The entrapment is often located at the middle scalene muscle. This presents as a lateral displacement of the scapula on the affected side. In addition, patients report limited range of motion in their shoulders and sharp or aching pain along the medial border of the scapula that can radiate to the lateral aspect of the upper limb.