Final Exam Cram Flashcards
What is the most sensitive indicator of joint disease?
ROM Testing
Describe Apprehension test
- Patient seated
- Dr beside patient abducting their shhulder to 90 and then push it into external rotation
- Positive is if they show apprehension
- Glenohumeral instability
Empty can test
- Flex shoulders 90 and abduct to 45, internally rotate arms so thumbs face down
- Push down on forearm ask patient to resist
- is if pain or weakness indicating supraspinatus pathology
Drop arm test
- Abduct arm to 90 slowly return it to neutral
- is if arm drops uncontrolled indicates supraspinatus pathology
Painful arc test
- Abduct arm from neutral
- is pain btw 60-120 indicating subacromial bursa impingement or rotator cuff
Neer Impingement
- Stabilize shoulder and pronate forearm, passively flex shoulder into full flexion
- is pain indicates subacromial bursa impingement or rotator cuff impingement
Hawkins test
- Flex shoulder to 90 and elbow to 90 (make a hawk wing)
- Passively internally roate shoulder
- pain for subacromail bursa impingement or rotator cuff impingement
Cross Arm test
- Passively adduct arm across patients chest and rest hand on their opposite shoulder
- Monitor posterior AC joint
- AC joint pain or increased TTA indicating AC pathology
Spencers Technique?
Elephantss Fart Constantly To Annoy All Intelligent Tigers
- Extension
- Flexion
- Compression w/ circumduction
- Traction Circumduction
- ABduction w/ ext rotation
- ADDuction
- Internal Rotation
- Traction with inferior glide
Patient is lateral recumbent with injured shoulder UP
Patient has tenderness and pain when raising arm above head, pain is more prevalent at night and pain over lateral deltoid. What could this be?
Rotator Cuff injury
What can cause Referred shoulder pain?
- MI
- Pulmonary issues such as embolism or apical lung tumor
- Abdominal issues uch as hepatobiliary disease or intraperitoneal blood
- Herpes Zoster
- Spinal cord lesion
- TOS
- Radiculopathy
When the scapula depresses what happens to hte AC and SC joint?
- AC: inferiorly glides
- SC: Superiorly glides
The GH flexes so the scapula ____ making the AC joint____ and SC joint ___.
- Protracts
- Anteriorly glides
- Posteriorly glides
If the SC joint is in an inferior glided position what is happening to the AC, shoulder and scapula?
- Abduction of shoulder
- Superior glide of AC joint
- Elevation of scapula
What happens to the SC joint with internal and external rotaion?
NOTHING trick question, only the AC joint does internal and external rotation
Patient presents with neck pain and denies any trauma to cause it. Her sx inculde pain, spasm, decreased ROM and a headache stemming from the occipital region. What could her problem be?
Myofascial neck pain such as whiplash or muscle strain
What is a SCIWORA?
- Spinal Cord Injury Without Radiographic Abnormality
- Rare and requires a high suspicion as the patient has normal CT, but continues to have neuro signs and symptoms
- It is more common in kids and elderly
- Must keep spine immobilized until Neurosurgeon consult and MRI
What are the three kinds of Torticollis?
- Congenital: from musclar fibrosis of SCM
- Adult: Acquired from SCM or Traps injury/inflammation, cervical muscle spasm or cervical nerve irritation
- Life threatening causes: Retropharyngeal abscess, C spine injury, CNS turmor or spinal epidural hematoma
What is the most common cause of acute and chronic neck pain in adults?
Cervical Spondylosis
Differnece between Myelopathy and Radiculopathy?
- Myelopathy is a defecit related to the spinal cord, has emergent symptoms requiring immediate MRI such as loss of bladder or bowel control, or patient complains weakness numbness bilaterally, clumsy hands, gait distrubances, sexual dysfunctions
- Radiculopathy is a “pinched nerve”, a neurologic deficit occuring at/near the root. Sharp radiating pain down arm, weakness or paresthesia can develop
- C5-6 are most commmon
What are the 11 redflags in patients with neck pain?
- Recent neck trauma
- Sx that suggest spinal cord injury such as loss bladder/bowel control
- Shock like paresthesia
- Fever chills
- Hx of IV drug
- Immunosuppression
- Chronic glucocorticoid use
- Unexplained weight loss
- Heachache shoulder hip pain or visual sx in older adults
- Anteior neck pain
- Hx of cancer
Describe the 3 specialty tests for suspected Radiculopathy?
- Neck compression: seated pt, dr behind place hands on top of head and press down, pain is positive
- Neck Distraction: seated pt, dr behind place one hand under chin other on occiput and pull upwards, positive is alleviation of pain
- Spurlings: essentially the compresion test only in three stages, first stage is neutral, second extend and compress, third extend SB to affected side and compress
- DO NOT continue if pain is reproduced
What are the special tests for TOS? Describe the short ones.
- Roos/EAST: abduct shoulders 90 flex elbows 90 externally rotate 90 and alternate making a fist 3 minutes
- Costoclavicular: seated with elbow exttended and hand supinated find radial pulse place hand on top of shoulder and extend the patients arm and apply downard pressure
- tests entrapment of neurovasucalture btw 1st rib and clavicle
- Wright’s Hyperabduction: seated elbow extended and hand supinated, dr beside find radial pulse, abduct arm above head with slight extension
- Testing for neurovasculature compression by pec minor
- Adsons
Describe Adsons and what is it for?
- TOS
- patient seated with elbow extended and hand supinated
- dr monitor radial pulse and abduct extetnd and externally rotate arm
- Ask patient to extend and rotate their head towards that arm and hold their breath
- pain indicates subclavian compressed btw 1st rib and clavicle
- Return to neutral and then ask patient to look away from that arm and hold their breath
- pain indicates compression of subclavian btw anteriro and middle scalenes