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Advanced Physical Dx > Elbow and Shoulder Exam > Flashcards

Elbow and Shoulder Exam Flashcards

1
Q

What are common shoulder problems pts complain of?

A
  1. Stiffness
  2. Pain
  3. Instability
  4. Decreased ROM
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2
Q

What inspection components are involved in the PE of the upper extremities?

A
  1. Compare shoulder contours (anteriorly)
    A. Alignment of clavicles
  2. Symmetry of sternoclavicluar and acromioclavicular (AC) joints
  3. Scpaula (posteriorly)
  4. Note scars, masses, lesions, abrasions, bruising, and erythema of the skin at and around the shoulders
  5. Note swelling, deformity, muscle atrophy, and asymmetry of the soft tissues and bones
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3
Q

What needs to be palpated on the UE exam?

A
  1. Temperature
  2. Tenderness
    A. Clavicle
    B. AC Joint
    C. Humerus
    D. Biceps tendon
    E. Supraspinatus tendon
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4
Q

What ROM needs to be examined for UE exam?

A 
Flexion 
Extension
Abduction 
Adduction 
Internal rotation (IR) 
External rotation (ER)
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5
Q

How is forward flexion assessed?

A

Forward Flexion: “raise both your arms in front of you until they are straight above your head:
0 degrees straight down
180 degrees straight up

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6
Q

How is ER and ABD assessed in UE exam?

A

External Rotation and Abduction: “place both your hands behind your neck with your elbows out to the sides:

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7
Q

How is Abd and Add assessed?

A

“raise both arms from your sides straight over head, palms together; now bring them slowly down to your side again”

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8
Q

How is extension and IR assessed?

A

“bring you arms toward your back and place your hands between the shoulder blades”

most can reach lower border of scapula (T7)

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9
Q

Where does UE strength need to be assessed? How is it documented?

A 
Check strength in each plane of motion
Flexion
Extension
Abduction
Adduction
IR
ER
Documented as 1-5 out of 5 (ie 5/5 nl)
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10
Q

What is Apley’s Scratch test?

A
  1. Tests for limitations in motions of the upper extremity. Each motion is performed bilaterally to compare.
    Action 1: The subject is instructed to touch the opposite shoulder with his/her hand. This motion checks Glenohumeral adduction, internal rotation, horizontal adduction and scapular protraction.
    Action 2: The subject is instructed to place his/her arm overhead and reach behind the neck to touch his/her upper back. This motion checks Glenohumeral abduction, external rotation and scapular upward rotation and elevation.
    Action 3: The subject puts his/her hand on the lower back and reaches upward as far as possible. This motion checks glenohumeral adduction, internal rotation and scapular retraction with downward rotation
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11
Q

What is the empty can test?

A

A. Testing supraspinatus strength
B. Helpful to distinguish between shoulder impingement/RCT
C. Interpretation:
D. Arm weakness is suspect for RCT
E. Patient sitting or standing
F. Shoulders abducted 45 degrees, forward flexed 45 degrees, and internally rotated
G. Patient attempts to resist downward pressure

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12
Q

What is the drop arm test?

A
  1. Shoulder placed in empty can position then pt asked to maintain position
  2. Perform when pt unable to perform active abduction of shoulder
  3. Test for RTC strength
  4. Suspect rotator cuff tear
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13
Q

What is the interpretation of the drop arm test?

A
  1. Arm drops to side quickly, pain, “ratcheting motion” in alternative test
  2. Probable RCT
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14
Q

What does Speed’s Test assess?

A

Test for Biceps strength

Test for Bicipital tendonopathy

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15
Q

What is the interpretation of Speed’s test?

A

Bicep tendonitis

Possible labral tear

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16
Q

How is SPeed’s test performed?

A

Supinated arm flexed forward 90 degrees

Downward resistance against forward flexion

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17
Q

What does Yergason’s test assess, and how is it performed?

A

Test for subluxation of biceps tendon out of bicipital groove
Shake pt’s hand
Resistance against supination
May be able to palpate actively subluxing long head of the biceps

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18
Q

What does the apprehension sign test for?

A

Testing for anterior shoulder instability

Possible torn labrum

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19
Q

What is a positive interpretation of the apprehension sign?

A

Positive if produces pain and/or shifting

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20
Q

How is an apprehension test performed?

A 
Arm 90 degree of abduction
Externally rotate SLOWLY
Watch pt’s face
Stop if pain or sensation of subluxation present
Can perform supine as well
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21
Q

What does the cross arm test assess?

A

Test for shoulder instability

Helps differentiate AC joint pain from impingement

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22
Q

What is the interpretation of the cross arm test?

A

Pain indicates positive test
Acromioclavicular joint disease
Sternoclavicular disease

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23
Q

How is the cross arm test performed?

A

Cross-arm test to check for AC joint arthrosis
Elevate to 90 degrees
Actively adduct

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24
Q

What does Hawkin’s Kennedy test assess?

A

Test for shoulder impingement

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25
Q

What is the interpretation of Hawkin’s Kennedy test?

A

Pain is a positive test that suggests impingement of the rotator cuff

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26
Q

How is Hawkin’s Kennedy test performed?

A

Shoulder and elbow Flexed to 90 degrees
Support at the elbow
Passively internally rotate humerus

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27
Q

What does the Neer test assess?

A

Test for shoulder impingement

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28
Q

what is the interpretation of the Neer test?

A

Pain suggests impingement of the rotator cuff

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29
Q

How is the Neer Test performed?

A

Arm fully pronated
Touch your shoulder to your ear
Forced flexion
Passive or Active

30
Q

What does the Load and Shift Test assess?

A

Assess shoulder stability in AP direction

Postive test for glenohumoral instability is anterior or posterior displacement/subluxation

31
Q

How is the Load and shift test performed?

A

Scapula is stabilized in upright position (when supine

32
Q

What does a positive load and shift test indicate?

A

May indicate over abundance of laxity in capsular ligaments or possible labral tear

33
Q

What is the sulcus sign?

A

Pressure on elbow and hand creates a space between the glenoid cavity and head of humerus

34
Q

What is O’brien’s test?

A

maximal load upon ACJ and superior labrum

35
Q

What does O’Brien’s test assess?

A

Rules out a slap tear

36
Q

What can acute pain or trauma to the shoulder be due to?

A

Fractures
Dislocations
Separations

37
Q

What are the characteristics of a clavicular fx? How is it treated?

A
  1. High energy injury
  2. Common
  3. Pain, swelling
  4. Most heal uneventful
  5. Sling, NSAID’s, surgical repair if severe
38
Q

Who is a proximal humerus fx common in? How is it treated?

A
  1. Elderly who fall, force is referred to proximal arm

2. Sling, joint replacement if severe

39
Q

What are the characteristics of anterior shoulder dislocation?

A

Trauma
Painful
Needs urgent reduction
May be recurrent

40
Q

How are anterior shoulder dislocations treated?

A

NSAID’s , sling, ortho referral

41
Q

What is the most common type of shoulder dislocation?

A

Anterior dislocation, accounting for 95% of cases

42
Q

How is the AC joint separated?

A

Trauma( Hockey,football,bikes ) – from fall onto side or lateral blow

43
Q

What are the grades asst. with ac joint separation?

A
  1. Grade I: slight displacement of the joint. The AC ligament many be stretched or partially torn. Most common type.
  2. Grade II: partial dislocation of the joint, the AC ligament is completely torn.
  3. Grade III: complete separation of the joint. The AC ligament, CC ligament and capsule are torn.
44
Q

How is AC joint separation treated?

A

Almost always treated conservatively

45
Q

What is the piano key sign and how is it performed? What injury is it asst. with?

A

Push down on involved clavicle (as you would a piano key) to determine if abnormal mov’t exists at the AC joint

AC joint dislocation

46
Q

What are chronic shoulder problems?

A 
Impingement:
Rotator cuff tear
Inflammatory:
DJD, Adhesive Capsulitis (Frozen shoulder)
Tumors:
Malignant and benign
47
Q

Define calcific tendonitits?

A
  1. Pathophysiology thought to be from repetitive trauma (impingement) causing increased calcium deposition
  2. Painful ROM
  3. NSAID’s or cortisone injection
48
Q

What are the symptoms of impingement?

A
  1. Repetitive use
  2. Painful arc
  3. Reduced ROM
  4. Pain with resisted motion
49
Q

What are the tx options for impingement?

A
  1. NSAID’s
  2. PT
  3. Cortisone injection
  4. Surgery
50
Q

What are the types of biceps tear injuries?

A

Partial tears.Many tears do not completely sever the tendon.
Complete tears.A complete tear will split the tendon into two pieces.

51
Q

What are the causes of biceps tear injuries?What are the risk factors?

A

Injury or Overuse

Age, heavy overhead activities, shoulder overuse, smoking

52
Q

What is the tx for biceps tear injuries?

A

Non-surgical: Ice, NSAIDs, rest, PT

Surgery is rare

53
Q

What are adhesive capsulitis (frozen shoulder?) characteristics

A

More chronic following injury, inflammation
Stiffness
Reduced ROM

54
Q

What diseaes is frozen shoulder asst. with?

A

Associated with Diabetes

55
Q

How is frozen shoulder treated?

A

PT – can take up to a year to improve
Cortisone injection
Surgery – lyse adhesions and manipulate to regain motion

56
Q

What needs to be inspected on an elbow injury?

A 
Redness,swelling, deformity
Lateral and medial epicondyles
Olecranon
“Carrying angle” (nl 9-14 deg when extended and forearm supinated)
physiological valgus of
elbow- it is increased when
carrying a load.
57
Q

What ROM needs to be exxamined for the elbow?

A

Extension 0 deg
Flexion 150 deg
Pronation 70 deg
Supination 90 deg

58
Q

What needs to be palpated on the elbow?

A 
Olecranon
Medial and Lateral epicondyles
Radial head
Biceps tendon insertion
Triceps tendon insertion
59
Q

What strength tests needs to be performed for elbow injuries?

A

Medial flexors and pronators
Lateral extensors and supinators
Biceps
Triceps

60
Q

What does the varus and valgus stress test asses? How is it performed?

A 
Test checks for stability
Varus stress test checks lateral (radial) collateral ligament 
Valgus stress test checks medial collateral ligament
CAN’T DO THIS WHEN FULLY EXTENDED
Elbow is locked
Elbow flexed 20-30 deg
One hand on wrist , the other on elbow
Apply valgus stress to elbow
61
Q

Define lateral epicondylitis test

A

Stabilize elbow
Pronate and radially deviates forearm
Extend wrist against resistance

62
Q

What is a positive result for tennis elbow test?

A

Positive test w/ pain +/- muscle weakness (ECRB)

63
Q

What is the golfer’s elbow test?

A

Stabilize elbow
Supinate the forearm
Extend elbow, wrist and fingers

64
Q

What is a positive golfer’s elbow test result?

A

+ test if pain +/- weakness (FCR)

65
Q

When is elbow extension testing performed?

A

Test performed following trauma

66
Q

What is the interpretation of the elbow extension test?

A

Inability to extend elbow= need for x-ray

67
Q

What are common elbow problems?

A

Olecranon bursitis (aseptic vs septic)
Fractures
Tendon rupture
Dislocation/Nursemaid’s elbow

68
Q

Define nursemaid’s elbow

A

Most common between 1-3 years old

Child will not use arm and hold slightly flexed

69
Q

What is the treatment for nursemaid’s elbow?

A

The forearm is supinated or pronated and flexed at same time. You will here a CLICK

70
Q

Define a distal biceps tendon rupture

A

Adistal biceps ruptureoccurs when the tendon attaching the biceps muscle to the elbow is torn from the bone.

71
Q

When does a distal biceps tendon rupture occur? How common is it?

A

This injury occurs mainly in middle-aged men during heavy work or lifting.
Distal biceps ruptures make up only three percent of all biceps tendon ruptures.

72
Q

What is the tx for distal biceps tendon rupture?

A

Surgery

Advanced Physical Dx (9 decks)

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